Healthcare Provider Details

I. General information

NPI: 1447865993
Provider Name (Legal Business Name): DERRON DORLOUIS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2020
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 E JERSEY ST
ELIZABETH NJ
07201-2310
US

IV. Provider business mailing address

4770 WHITE PLAINS RD
BRONX NY
10470-1104
US

V. Phone/Fax

Practice location:
  • Phone: 908-352-9800
  • Fax:
Mailing address:
  • Phone: 718-931-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number26NJ01048100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: