Active NPI
Anne Krikor Derderian, DDS
- Dentist
- Corona, NY
National Provider Identifier
1245418862
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 035878
- Practice address
- 10620 Otis Ave
Corona, NY 11368 - Phone
- (718) 271-0661
- Fax
- (718) 520-0888
- NPI assigned
- Feb 6, 2008
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 035878 | NY | Primary |
Addresses
Primary practice location
10620 Otis Ave
Corona, NY 11368
Mailing address
10620 Otis Ave
Corona, NY 11368
Phone (718) 271-0661
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1202256000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1202256000000",
"number": "1245418862",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10620 OTIS AVE",
"city": "CORONA",
"state": "NY",
"postal_code": "11368",
"telephone_number": "718-271-0661",
"fax_number": "718-520-0888"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10620 OTIS AVE",
"city": "CORONA",
"state": "NY",
"postal_code": "11368",
"telephone_number": "718-271-0661",
"fax_number": "718-520-0888"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DERDERIAN",
"first_name": "ANNE",
"middle_name": "KRIKOR",
"name_prefix": "Mrs.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-02-06",
"last_updated": "2008-02-06",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "035878",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Corona, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.