Healthcare Provider Details

I. General information

NPI: 1063562445
Provider Name (Legal Business Name): DAVID MICHAEL DERAMO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 BERGENLINE AVE STE 302
WEST NEW YORK NJ
07093-5616
US

IV. Provider business mailing address

5300 BERGENLINE AVE STE 302
WEST NEW YORK NJ
07093-5616
US

V. Phone/Fax

Practice location:
  • Phone: 201-510-9999
  • Fax: 201-252-0058
Mailing address:
  • Phone: 201-510-9999
  • Fax: 201-252-0058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number25MA08226000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: