Provider Demographics
NPI:1639144611
Name:DERKATZ, DANUTA T (MD)
Entity Type:Individual
Prefix:DR
First Name:DANUTA
Middle Name:T
Last Name:DERKATZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8875 PORTER RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-1694
Mailing Address - Country:US
Mailing Address - Phone:716-298-0460
Mailing Address - Fax:716-298-0462
Practice Address - Street 1:8875 PORTER RD
Practice Address - Street 2:SUITE 3
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-1694
Practice Address - Country:US
Practice Address - Phone:716-298-0460
Practice Address - Fax:716-298-0462
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195230207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01541937Medicaid
NYF88545Medicare UPIN
NY01541937Medicaid