Derik E Stucker, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

054444 Issued in NY

Practice address

3360 Route 343
Hudson River Healthcare, Inc.
Amenia, NY 12501-5619

Phone

(845) 838-7038

Fax

(845) 373-7021

NPI assigned

Apr 29, 2008

Last updated

Feb 19, 2014By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1209427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1392768000000",
    "number": "1336314400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1037 MAIN ST",
            "address_2": "HUDSON RIVER HEALTHCARE, INC.",
            "city": "PEEKSKILL",
            "state": "NY",
            "postal_code": "105662913",
            "telephone_number": "914-734-8800",
            "fax_number": "845-373-7021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3360 ROUTE 343",
            "address_2": "HUDSON RIVER HEALTHCARE, INC.",
            "city": "AMENIA",
            "state": "NY",
            "postal_code": "125015619",
            "telephone_number": "845-838-7038",
            "fax_number": "845-373-7021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STUCKER",
        "first_name": "DERIK",
        "middle_name": "E",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-04-29",
        "last_updated": "2014-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NM",
            "license": "TD-00-19",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "054444",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03541646",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stacey Joy Reilly, RPH
• Keelin Sepp
• Christine Mary Sergent, RD, CDN
• Lisa Ann Straus, M.D.
• Jordan Stroly, MS, CCC-SLP
• Sun River Health Inc
• Rachel Perlmutter Tantri, A.R.N.P.
• Karen Elizabeth Thompson, CCCSLP
• Cara Tomasetti
• Kathy Valoy, RPH

• Dentist in Amenia, NY
• Providers in Amenia, NY by specialty
• Dentist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.