Provider Demographics
NPI:1114214590
Name:SILVERMAN, DERECK C (PT, DPT)
Entity Type:Individual
Prefix:
First Name:DERECK
Middle Name:C
Last Name:SILVERMAN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 IVY LN
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-3701
Mailing Address - Country:US
Mailing Address - Phone:845-596-4372
Mailing Address - Fax:
Practice Address - Street 1:26 IVY LN
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-3701
Practice Address - Country:US
Practice Address - Phone:845-596-4372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01411500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist