MEDICARE: JANET DERICO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	F311945-01	NY

General Provider Information

NPI Number	:	1609602523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANET DERICO

Provider Business Mailing Address
First Line	:	PO BOX 51
Second Line	:
City	:	BUCHANAN
State	:	NY
Zip	:	10511-0051
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4 HDSN VLY PROF PLZ STE 2
Second Line	:
City	:	NEWBURGH
State	:	NY
Zip	:	12550-3157
Country	:	US
Telephone Number	:	781-530-0070
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2024
Last Update Date	:	09/09/2024

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Directions to “ JANET DERICO ” Practice Location

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