Provider Demographics
NPI:1255733945
Name:SADDLER, DERMAINE B
Entity type:Individual
Prefix:
First Name:DERMAINE
Middle Name:B
Last Name:SADDLER
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 1:3308 WICKHAM AVE
Mailing Address - Street 2:APT. 1
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-2736
Mailing Address - Country:US
Mailing Address - Phone:347-463-3552
Mailing Address - Fax:
Practice Address - Street 1:3308 WICKHMA AVENUE
Practice Address - Street 2:APT. 1
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469
Practice Address - Country:US
Practice Address - Phone:347-463-3552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-24
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY319142164W00000X
NY755166163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse