Active NPI
George Dermesropian
- Surgery of the Hand (Surgery) Physician
- Fulton, NY
National Provider Identifier
1407045446
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery of the Hand (Surgery) Physician
- License
- 103942
- Practice address
- 455 South Fourth Street
Fulton, NY 13069-3069 - Phone
- (315) 598-3585
- NPI assigned
- Oct 16, 2007
- 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 |
|---|---|---|---|---|
| Surgery of the Hand (Surgery) Physician | 2086S0105X | 103942 | NY | Primary |
Addresses
Primary practice location
455 South Fourth Street
Fulton, NY 13069-3069
Mailing address
455 South Fourth Street
Fulton, NY 13069-3069
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02172205 | Medicaid | NY |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 103942 | NY | MD | Surgery of the Hand (Surgery) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1192492800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1192492800000",
"number": "1407045446",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "455 SOUTH FOURTH STREET",
"city": "FULTON",
"state": "NY",
"postal_code": "130693069"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "455 SOUTH FOURTH STREET",
"city": "FULTON",
"state": "NY",
"postal_code": "130693069",
"telephone_number": "315-598-3585"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DERMESROPIAN",
"first_name": "GEORGE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-10-16",
"last_updated": "2007-10-16",
"status": "A"
},
"taxonomies": [
{
"code": "2086S0105X",
"taxonomy_group": "",
"desc": "Surgery, Surgery of the Hand",
"state": "NY",
"license": "103942",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02172205",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fulton, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.