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General NPI Number Information
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NPI Number | 1821035262
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Entity Type | Individual
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Provider Name | JACQUES A DERZIE MD
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Gender | Male
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Dates
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Enumeration Date | 06/02/2006
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Last Update Date | 12/30/2008
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Provider Practice Location Address
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Address Line | 1840 LAKEVILLE ROAD
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City | NEW HYDE PARK
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State | NY
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Zip | 11040-1930
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Country | US
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Telephone | 516-354-1234
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Fax | 516-354-6385
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Provider Business Mailing Address
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Address Line | 1840 LAKEVILLE ROAD
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City | NEW HYDE PARK
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State | NY
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Zip | 11040-1930
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Country | US
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Telephone | 516-354-1234
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Fax | 516-354-6385
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 099934
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License Number State | NY
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