Provider Demographics
NPI:1417248865
Name:DEYERMOND, PHILIP
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:DEYERMOND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 FRAZIER RD
Mailing Address - Street 2:
Mailing Address - City:ELDRED
Mailing Address - State:NY
Mailing Address - Zip Code:12732-5215
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19 FRAZIER RD
Practice Address - Street 2:
Practice Address - City:ELDRED
Practice Address - State:NY
Practice Address - Zip Code:12732-5215
Practice Address - Country:US
Practice Address - Phone:845-291-4112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011638225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist