Joseph N Deraville Sr., PA-C
Individual provider Active NPI Medical Physician Assistant · Iselin, NJ
NPI 1144536152 · NPPES record last updated Aug 27, 2010
Key facts
- NPI
- 1144536152
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- 25MP00142700 (NJ)
- Practice address
- 557 New Dover Rd
Iselin, NJ 08830-1127 - Phone
- (732) 388-4128
- NPI assigned
- Aug 27, 2010
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 25MP00142700 | NJ | Yes |
Addresses
Primary practice location
557 New Dover Rd
Iselin, NJ 08830-1127
Mailing address
557 New Dover Rd
Iselin, NJ 08830-1127
Phone (732) 388-4128
Other providers in Iselin, NJ
- Dana Decarlo
- Delight Home Care LLC
- Jerome Delrosario
- Delta Community Supports, Inc.
- Anthony Peter Demarco
- Hetasvi Jay Desai
- Eric Robert Devore
- Jana Didonato
- Dipasquale Chiropractic
- Tannia Carolina Dominguez
All providers in Iselin, NJ · Medical Physician Assistant in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 27, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.