Healthcare Provider Details

I. General information

NPI: 1649699232
Provider Name (Legal Business Name): DEREK HO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2014
Last Update Date: 08/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 CLARKSON AVE # MSC30
BROOKLYN NY
11203-2012
US

IV. Provider business mailing address

450 CLARKSON AVE # MSC30
BROOKLYN NY
11203-2012
US

V. Phone/Fax

Practice location:
  • Phone: 718-270-8995
  • Fax:
Mailing address:
  • Phone: 718-270-8995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number300267
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: