DR. JOHN P. DERVAN (NPI# 1871524439) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871524439 |
| Entity Type | Individual |
| Full Name | DR. JOHN P. DERVAN |
| Credential | MD |
| Practice Address |
1320 Stony Brook Rd Ste 100 Stony Brook NY 11790 |
| Mailing Address |
1320 Stony Brook Road Building D, Suite 100 Stony Brook NY 11790 |
| Practice Telephone | 6319412273 |
| Practice Fax Number | 6319412501 |
| Mailing Telephone | 6319412273 |
| Mailing Fax Number | 6319412501 |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2018-09-25 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
166207 | NY | Allopathic & Osteopathic Physicians |
| N | 207RI0011X |
Internal Medicine Specialization: Interventional Cardiology |
166207 | NY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NV | 00964109 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 220 Belle Mead Rd, Suite A, E. Setauket, NY 11733 | 6319412273 | 6319412501 |
| Street Address |
1320 STONY BROOK RD STE 100 |
| City | STONY BROOK |
| State | NY |
| Zip Code | 11790 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366042764 | Alyssa Nicole Venezia | Nurse Practitioner | 1320 Stony Brook Rd Ste 100, Stony Brook, NY 11790-2222 | 2020-10-27 |
| 1861967515 | Kerrin Elizabeth Rowe | Nurse Practitioner | 1320 Stony Brook Rd Ste 100, Stony Brook, NY 11790-2222 | 2018-10-09 |
| 1467892414 | Arash Ehteshami Afshar | Internal Medicine | 1320 Stony Brook Rd Ste 100, Stony Brook, NY 11790-2222 | 2013-07-03 |
| 1255523973 | Donna Lee Boehm | Clinical Nurse Specialist | 1320 Stony Brook Rd Ste 100, Stony Brook, NY 11790-2222 | 2007-08-16 |
| 1770679557 | Daniel R. Montellese | Internal Medicine | 1320 Stony Brook Rd Ste 100, Stony Brook, NY 11790 | 2006-10-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649807678 | Ribu Mathew | Student in an Organized Health Care Education/Training Program | Health Science Center T16, Room 020, Stony Brook, NY 11790 | 2020-03-27 |
| 1538794821 | Chaoyang Qu | Student in an Organized Health Care Education/Training Program | 9 Syncamore Dr, Stonybrook, NY 11790 | 2020-03-06 |
| 1457814824 | Brain & Spine Surgery, P.C. | Neurological Surgery | 2500 Nesconset Hwy., Bldg 18c, Stony Brook, NY 11790 | 2019-04-11 |
| 1447759741 | Susan Cuccia | Registered Nurse | 40 Sheppard Lane, Stony Brook, NY 11790 | 2018-02-02 |
| 1972022234 | Carol M Doherty | Specialist | 7 Haskel Lane, Stony Brook, NY 11790 | 2017-09-18 |
| 1972021582 | Louren M Gonzales | Nurse Practitioner | 100 Nicolls Rd Hsc Level 4 Room 120, Hsc Level 4 Room 120, Stony Brook, NY 11790 | 2017-09-04 |
| 1043740954 | Asma Khattak | Behavior Technician | 90 Quaker Path, Stony Brook, NY 11790 | 2017-06-13 |
| 1427452846 | Christina Georgia | Registered Nurse | 36 Ivy League Lane, Stony Brook, NY 11790 | 2014-10-14 |
| 1124361654 | Mandeep Kainth | Student in an Organized Health Care Education/Training Program | Department of Medicine Hsc Level 16, 020, Suny Stony Brook, Stony Brook, NY 11790 | 2013-04-03 |
| 1922357144 | Audry M Luciano | Registered Nurse | 2500 Nesconset Hwy Bldg 23, Stony Brook, NY 11790 | 2012-09-04 |
| Find all providers in zip 11790 | ||||
| Taxonomy Code | 207RC0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Cardiovascular Disease |
| An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558421057 | Joseph Chernilas | Internal Medicine | Cardiology Division, Hsc-t-16 R-080 Suny, Stony Brook, NY 11794-0001 | 2006-12-12 |
| 1770513863 | Mitchell A Saunders | Internal Medicine | 1320 Stony Brook Rd Building D Suite 100, Stony Brook, NY 11790-2222 | 2006-07-04 |
| 1548689821 | Michael Gavalas | Internal Medicine | 101 Nicolls Rd, Stony Brook, NY 11794-3720 | 2014-04-15 |
| 1235440652 | Adil Sattar | Internal Medicine | 100 Nicolls Road, Cardiology, Hsc T16-080, Stony Brook, NY 11794 | 2010-06-30 |
| 1255657227 | Michael Goyfman | Internal Medicine | Hsc T16 080, Stony Brook, NY 11794-8167 | 2010-04-15 |
| 1649415290 | Puja Parikh | Internal Medicine | Hsc T16 080, Stony Brook, NY 11794-8167 | 2008-12-11 |
| 1821265463 | Kaveh Sadigh | Internal Medicine | Hsc T16 080, Stony Brook, NY 11794-8167 | 2008-05-13 |
| 1831233576 | Szilard Voros | Internal Medicine | Hsc Level 4 Rm 120, Stony Brook, NY 11794-8460 | 2007-02-16 |
| 1508928128 | Roger Fan | Internal Medicine | Health Sciences Ctr, T16-080, Stony Brook, NY 11794-0001 | 2006-12-14 |
| 1043245764 | Smadar Kort | Internal Medicine | University Hospital, L5, Stony Brook, NY 11794 | 2006-07-11 |
| Find all providers in STONY BROOK | ||||
| City | STONY BROOK |
| Zip Code | 11790 |
Please comment or provide details below to improve the information on DR. JOHN P. DERVAN.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.