Active NPI
Natacha Derival
- Physician Assistant
- Wayne, NJ
National Provider Identifier
1265061402
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 1700 NJ-23 # 170
Wayne, NJ 07470 - Phone
- (732) 338-7202
- NPI assigned
- Apr 8, 2020
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Primary |
Addresses
Primary practice location
1700 NJ-23 # 170
Wayne, NJ 07470
Mailing address
1700 NJ-23 # 170
Wayne, NJ 07470
Electronic endpoints 4
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | hippa | ||
| Other URL | fax | ||
| Other URL | qep4ever@hotmail.com | ||
| CONNECT URL | qep4ever@gmail.com |
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": "1586304000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1586304000000",
"number": "1265061402",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1700 NJ-23 # 170",
"city": "WAYNE",
"state": "NJ",
"postal_code": "07470"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1700 NJ-23 # 170",
"city": "WAYNE",
"state": "NJ",
"postal_code": "07470",
"telephone_number": "732-338-7202"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DERIVAL",
"first_name": "NATACHA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-04-08",
"last_updated": "2020-04-08",
"certification_date": "2020-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "hippa",
"affiliation": "N",
"address_1": "1700 NJ-23 # 170",
"city": "Wayne",
"state": "NJ",
"country_code": "US",
"postal_code": "07470",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "fax",
"affiliation": "N",
"address_1": "1700 NJ-23 # 170",
"city": "Wayne",
"state": "NJ",
"country_code": "US",
"postal_code": "07470",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "qep4ever@hotmail.com",
"affiliation": "N",
"address_1": "1700 NJ-23 # 170",
"city": "Wayne",
"state": "NJ",
"country_code": "US",
"postal_code": "07470",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "qep4ever@gmail.com",
"affiliation": "N",
"address_1": "1700 NJ-23 # 170",
"city": "Wayne",
"state": "NJ",
"country_code": "US",
"postal_code": "07470",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Wayne, NJ
- Shaghayegh Moghaddam Denoble, M.D.
- Department of Special Education of the Roman Catholic Diocese of Pater
- Department of Special Education of the Roman Catholic Diocese of Pater
- Department of Special Education of the Roman Catholic Diocese of Pater
- Emily Dequinzio, MS, OTR/L
- Elizabeth Derka, PHARMD
- Jamie Deruyter Swart, LPC
- Meghna Desai
- Nawal M Desoky, M.D.
- Rachael Theresa Detore
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.