Active NPI
Derrick Trent, L.AC
- Pain Medicine Physician
- New York, NY
National Provider Identifier
1265934913
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pain Medicine Physician
- License
- 006211-1
- Practice address
- 626 Riverside Dr Apt 21C
New York, NY 10031-7230 - Phone
- (212) 419-4904
- NPI assigned
- Mar 8, 2018
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Pain Medicine Physician | 208VP0000X | 006211-1 | NY | Primary |
Addresses
Primary practice location
626 Riverside Dr Apt 21C
New York, NY 10031-7230
Mailing address
626 Riverside Dr Apt 21C
New York, NY 10031-7230
Phone (212) 419-4904
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 |
|---|---|---|---|
| 006211-1 | NY | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1520467200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1520467200000",
"number": "1265934913",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "626 RIVERSIDE DR APT 21C",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100317230",
"telephone_number": "212-419-4904"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "626 RIVERSIDE DR APT 21C",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100317230",
"telephone_number": "212-419-4904"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TRENT",
"first_name": "DERRICK",
"credential": "L.AC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-03-08",
"last_updated": "2018-03-08",
"status": "A"
},
"taxonomies": [
{
"code": "208VP0000X",
"taxonomy_group": "",
"desc": "Pain Medicine, Pain Medicine",
"state": "NY",
"license": "006211-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.