Stevenson Derodar

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

008240 Issued in NY

Practice address

765 Riverside Dr
New York, NY 10032-7358

Phone

(718) 377-5000

NPI assigned

Mar 16, 2022

Last updated

Mar 16, 2022By the provider in NPPES

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1647388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647388800000",
    "number": "1982352118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "765 RIVERSIDE DR",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100327358",
            "telephone_number": "718-377-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "765 RIVERSIDE DR",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100327358",
            "telephone_number": "718-377-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERODAR",
        "first_name": "STEVENSON",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-03-16",
        "last_updated": "2022-03-16",
        "certification_date": "2022-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "NY",
            "license": "008240",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marjorie Dermer, PHD
• Jeffrey V. Dermksian, MD
• Matthew Dermksian
• Evelyn Derobertis
• Jeffrey Michael Deroche, LCSW
• Cenci Deromero
• Amelia Derosa
• Michael Joseph Derosa, NP
• Rosemary Derosa, RN
• Gia Derose, DO

• Physical Therapy Assistant in New York, NY
• Providers in New York, NY by specialty
• Physical Therapy Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.