Physician Compare National (NPI:1821035262)

HEALTHCARE PROVIDER: JACQUES A DERZIE MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1821035262
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3678634979
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20081204000900
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	DERZIE
	Individual professional last name
Provider First Name	JACQUES
	Individual professional first name
Provider Middle Name	A
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1964
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1840 LAKEVILLE RD
	Group Practice or individual's line 1 address
City	NEW HYDE PARK
	Group Practice or individual's city
State	NY
	Group Practice or individual's state
Zip Code	110401930
	Group Practice or individual's zip code (9 digits when available)
Phone Number	5163541234
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	330106
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	NS/LIJ HS-NORTH SHORE UNIVERSITY HOSPITAL AT MANHASSET
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y