Provider Demographics
NPI:1134457765
Name:DERROW, ALFRED MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:MARTIN
Last Name:DERROW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 CRAWFORD DR
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-7914
Mailing Address - Country:US
Mailing Address - Phone:631-499-8892
Mailing Address - Fax:
Practice Address - Street 1:16 CRAWFORD DR
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-7914
Practice Address - Country:US
Practice Address - Phone:631-499-8892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY091043207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine