Basic Information
| Provider Information | |||||||||
| NPI: | 1497778161 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LERNER | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 19 BRADHURST AVE | ||||||||
| Address2: | SUITE 3070N | ||||||||
| City: | HAWTHORNE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105322140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9143727887 | ||||||||
| FaxNumber: | 9143727884 | ||||||||
| Practice Location | |||||||||
| Address1: | 19 BRADHURST AVE | ||||||||
| Address2: | SUITE 3070N | ||||||||
| City: | HAWTHORNE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105322140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9143727887 | ||||||||
| FaxNumber: | 9143727884 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2006 | ||||||||
| LastUpdateDate: | 05/21/2015 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 086808 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 00135424 | 05 | NY | MEDICAID | 086808 | 01 | HIP | OTHER | 133277785 | 01 | POMCO | OTHER | 001076 | 01 | CONNECTICARE | OTHER | 113815 | 01 | WELLCARE | OTHER | 1000016495 | 01 | AFFINITY | OTHER | 110063277 | 01 | NY | RAILROAD MEDICARE | OTHER | LR8039 | 01 | ATLANTIS | OTHER | WS727 | 01 | OXFORD | OTHER | 00000043813 | 01 | NY | GHI HMO | OTHER | 0533021 | 01 | NY | AETNA HMO | OTHER | 40220770 | 01 | FIDELIS | OTHER | 0005291 | 01 | NY | GHI PPO | OTHER | 381615 | 01 | NY | MVP | OTHER | 5C9542 | 01 | NY | HEALTHNET | OTHER | 4396804 | 01 | NY | AETNA PPO | OTHER | 520771 | 01 | NY | BCBS OF NY | OTHER |