Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0000X | Hematologist | 107220 | NY |
NPI | 1467405613 |
---|---|
Provider Name | Beverly R Deren |
First Address | Mount Kisco, NY 10549-3412 |
Second Address | Mount Kisco, NY 10549-3412 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 19/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00188550 | (05) | NY |
0667910001 | DME (01) | NY |
700002769 | MEDICARE RAILROAD (01) | NY |