Dervan, John P.

Dervan, John P. is an individual health care provider with primary practice located at 100 Nicolls Rd # T-16030 , Stony Brook NY 11794-0001. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Interventional Cardiology, Allopathic & Osteopathic Physicians / Cardiovascular Disease. Allopathic & Osteopathic Physicians / Cardiovascular Disease is his primary health care specialty. Dervan, John P. can be contacted via phone (631) 444-3655.

Contact Information

Primary practice address
100 Nicolls Rd # T-16030 Stony Brook NY 11794-0001
Phone: (631) 444-3655
Fax: (631) 444-1054
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Interventional Cardiology 207RI0011X 166207 New York
Allopathic & Osteopathic Physicians / Cardiovascular Disease 207RC0000X 166207 New York

Profile Details

NPI number 1871524439
LBN Legal business name Dervan, John P.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 5th, 2006
Last updated Jan 25th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1871524439 NPPES
Nevada MEDICAID 00964109

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