Healthcare Provider Details

I. General information

NPI: 1013228469
Provider Name (Legal Business Name): KRISTINA DERRICK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2010
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 COMMONS WAY BLDG B
TOMS RIVER NJ
08755-6427
US

IV. Provider business mailing address

214 COMMONS WAY BLDG B
TOMS RIVER NJ
08755-6427
US

V. Phone/Fax

Practice location:
  • Phone: 732-234-7546
  • Fax: 732-231-5202
Mailing address:
  • Phone: 732-234-7546
  • Fax: 732-231-5202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number106526
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number25MA10534400
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number25MA10534400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: