Healthcare Provider Details

I. General information

NPI: 1215732664
Provider Name (Legal Business Name): DEREK MICHAEL VAN PEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2025
Last Update Date: 08/25/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 E 70TH ST
NEW YORK NY
10021
US

IV. Provider business mailing address

327-3228 TUPPER ST
VANCOUVER BC
V5Z4S7
CA

V. Phone/Fax

Practice location:
  • Phone: 212-746-2700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number327974
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: