Active NPI
Karen Dermer, DO
- Pediatrics Physician
- Stony Brook, NY
National Provider Identifier
1215564703
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 32180101
- Practice address
- 101 Nicolls Rd
Stony Brook, NY 11794-0001 - Phone
- (631) 444-2020
- Fax
- (631) 444-2894
- NPI assigned
- Mar 24, 2020
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 32180101 | NY | Primary |
| Pediatric Hematology & Oncology Physician | 2080P0207X | 036.170415 | IL |
Addresses
Primary practice location
101 Nicolls Rd
Stony Brook, NY 11794-0001
Mailing address
101 Nicolls Rd RM 40
Stony Brook, NY 11794-0001
Phone (631) 444-2020
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)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 32180101 | NY | MD | Pediatrics Physician |
| 036.170415 | IL | MD | Pediatric Hematology & Oncology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1585008000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1718064000000",
"number": "1215564703",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 NICOLLS RD RM 40",
"city": "STONY BROOK",
"state": "NY",
"postal_code": "117940001",
"telephone_number": "631-444-2020",
"fax_number": "631-444-2894"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 NICOLLS RD",
"city": "STONY BROOK",
"state": "NY",
"postal_code": "117940001",
"telephone_number": "631-444-2020",
"fax_number": "631-444-2894"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DERMER",
"first_name": "KAREN",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-03-24",
"last_updated": "2024-06-11",
"certification_date": "2024-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NY",
"license": "32180101",
"primary": true
},
{
"code": "2080P0207X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Hematology-Oncology",
"state": "IL",
"license": "036.170415",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stony Brook, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.