Active NPI
Michelle Marie Derkovitz, RPT
- Physical Therapist
- Buffalo, NY
National Provider Identifier
1053416560
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 017335-1
- Practice address
- 346 Delaware Avenue
Buffalo, NY 14202 - Phone
- (716) 856-7500
- NPI assigned
- Sep 13, 2006
- Last updated
- Feb 3, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 017335-1 | NY | Primary |
Addresses
Primary practice location
346 Delaware Avenue
Buffalo, NY 14202
Mailing address
6 Grace Way
Lancaster, NY 14086-2347
Phone (716) 651-0149
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 017335-1 | NY | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158105600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1328227200000",
"number": "1053416560",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6 GRACE WAY",
"city": "LANCASTER",
"state": "NY",
"postal_code": "140862347",
"telephone_number": "716-651-0149"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "346 DELAWARE AVENUE",
"city": "BUFFALO",
"state": "NY",
"postal_code": "14202",
"telephone_number": "716-856-7500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DERKOVITZ",
"first_name": "MICHELLE",
"middle_name": "MARIE",
"name_prefix": "Mrs.",
"credential": "RPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-13",
"last_updated": "2012-02-03",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "017335-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Buffalo, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.