Healthcare Provider Details

I. General information

NPI: 1457801540
Provider Name (Legal Business Name): DERBY NEMORIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2016
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 WILLOW AVE
HEMPSTEAD NY
11550-7034
US

IV. Provider business mailing address

125 WILLOW AVE
HEMPSTEAD NY
11550-7034
US

V. Phone/Fax

Practice location:
  • Phone: 516-439-0282
  • Fax:
Mailing address:
  • Phone: 516-439-0282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number008300-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: