Provider Demographics
NPI:1841284106
Name:TATE, DEREK MITCHELL (MD)
Entity type:Individual
Prefix:DR
First Name:DEREK
Middle Name:MITCHELL
Last Name:TATE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:270 BRONXVILLE RD
Mailing Address - Street 2:#A 53
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-2848
Mailing Address - Country:US
Mailing Address - Phone:646-413-1825
Mailing Address - Fax:914-202-9248
Practice Address - Street 1:36 W 44TH ST
Practice Address - Street 2:SUITE 1203
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-8102
Practice Address - Country:US
Practice Address - Phone:646-413-1825
Practice Address - Fax:914-202-9248
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-01
Last Update Date:2024-07-25
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Provider Licenses
StateLicense IDTaxonomies
NY2132092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
H48414Medicare UPIN
NY375BL1Medicare PIN