Provider Demographics
NPI:1811262082
Name:DERDEN LLC
Entity type:Organization
Organization Name:DERDEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENIZ
Authorized Official - Middle Name:M
Authorized Official - Last Name:PIRINCCI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-768-4670
Mailing Address - Street 1:388 GARDEN DR
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-1767
Mailing Address - Country:US
Mailing Address - Phone:585-768-4670
Mailing Address - Fax:585-768-4681
Practice Address - Street 1:3000 MOUNT READ BLVD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14616-4843
Practice Address - Country:US
Practice Address - Phone:585-865-3223
Practice Address - Fax:585-621-4128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY177398207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01124276Medicaid
NY11484AMedicare PIN
NY01124276Medicaid
NY12231AMedicare PIN