Giorgi Derevenskikh, MD

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

One Brookdale Plaza
Brookdale University Hospital Medical Center
Brooklyn, NY 11212-3139

Phone

(718) 240-5000

Fax

(718) 240-6516

NPI assigned

Jul 14, 2022

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1657756800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657756800000",
    "number": "1467186494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "ONE BROOKDALE PLAZA",
            "address_2": "BROOKDALE UNIVERSITY HOSPITAL MEDICAL CENTER",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112123139",
            "telephone_number": "718-240-5000",
            "fax_number": "718-240-6516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "ONE BROOKDALE PLAZA",
            "address_2": "BROOKDALE UNIVERSITY HOSPITAL MEDICAL CENTER",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112123139",
            "telephone_number": "718-240-5000",
            "fax_number": "718-240-6516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEREVENSKIKH",
        "first_name": "GIORGI",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-07-14",
        "last_updated": "2022-07-14",
        "certification_date": "2022-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David A. Derdzinski, M.D.
• Melissa Ellen Dere, MD
• Erimas Nimane Dereje
• Gabriella Jennifer Deren
• Rachel Michelle Deren
• Deborah Deriso, COTA
• Jean Derissaint, LPN
• Guertina Derisse
• Stacy Deristin
• Daline Derival, RN, MSN, FNP-BC

• Student in an Organized Health Care Education/Training Program in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Student in an Organized Health Care Education/Training Program in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2022; 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.