DR. MICHAEL M DEREN (NPI# 1972596534) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972596534 |
| Entity Type | Individual |
| Full Name | DR. MICHAEL M DEREN |
| Credential | MD, FACS, FCCP |
| Practice Address |
21 Montauk Ave Suite 104 New London CT 06320-4906 |
| Practice Telephone | 8604435469 |
| Practice Fax Number | 8604371170 |
| Mailing Telephone | 8604435469 |
| Mailing Fax Number | 8604371170 |
| Enumeration Date | 2005-08-29 |
| Last Update Date | 2012-03-01 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | 15198 | CT | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CT | HEALTHNET | 31362 | 01 |
| CT | OXFORD | NLS040 | 01 |
| CT | CONNECTICARE | 606090 | 01 |
| CT | 001151984 | 05 | |
| CT | AETNA | 4621903 | 01 |
| Street Address |
21 MONTAUK AVE SUITE 104 |
| City | NEW LONDON |
| State | CT |
| Zip Code | 06320-4906 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215909379 | Stephen Glenn Vance | Psychiatry & Neurology | 21 Montauk Ave, New London, CT 06320-4906 | 2006-02-03 |
| 1982189056 | Cassandra M Rice | Social Worker | 21 Montauk Ave, New London, CT 06320-4906 | 2018-09-25 |
| 1114421765 | Sarah Bochet | Social Worker | 21 Montauk Ave, New London, CT 06320-4906 | 2018-03-20 |
| 1356841415 | Madena Lynn Lewis | Nurse Practitioner | 21 Montauk Ave, New London, CT 06320 | 2018-02-15 |
| 1336655240 | Peggy Nelson | Counselor | 21 Montauk Ave, New London, CT 06320-4906 | 2017-12-15 |
| 1417469446 | Glorimar Anderson | Social Worker | 21 Montauk Ave, New London, CT 06320 | 2017-10-31 |
| 1295189389 | Kevin M Messier | Pharmacist | 21 Montauk Ave, Suite 102, New London, CT 06320-4906 | 2016-04-15 |
| 1821464017 | Ellen Louise Sollazzo | Nurse Practitioner | 21 Montauk Ave, New London, CT 06320-4906 | 2015-08-11 |
| 1275918732 | Rachael Mullen | Counselor | 21 Montauk Ave, New London, CT 06320-4906 | 2015-07-27 |
| 1982091781 | Bryan D Mccloskey | Counselor | 21 Montauk Ave, New London, CT 06320-4906 | 2015-04-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942824891 | Shilpi Jain | Physical Therapist | 31 Vauxhall Street, Beechwood Post Accute, Transitional, New London, CT 06320 | 2020-06-05 |
| 1174009641 | Catherine Hinojosa | Nurse Practitioner | 1 Shaws Cove, New London, CT 06320 | 2018-07-17 |
| 1043668320 | Cultivate & Grow Inc. | Counselor | 302 State St Suite 307, New London, CT 06320 | 2016-05-27 |
| 1295137263 | Jacqueline Durnell | Registered Nurse | 15 Mohegan Drive, Us Coast Guard Academy Regional Clinic, New London, CT 06320 | 2014-09-22 |
| 1922427541 | Corina Vendetto | Registered Nurse | 245 Shaw St., New London, CT 06320 | 2014-04-10 |
| 1912329962 | Janelle Posey-green | Social Worker | 302 State St., Suite 201, New London, CT 06320 | 2014-01-10 |
| 1750622692 | Cynthia Mitchell | Social Worker | 65b Michael Rd, New London, CT 06320 | 2013-03-01 |
| 1518254507 | Simon J Shapiro | Physical Medicine & Rehabilitation | 190 Howard Avenue, New London, CT 06320 | 2011-06-29 |
| 1184876708 | Jane P Genido-trujillo | Nurse Practitioner | 270 Mohegan Ave., Student Health Services, New London, CT 06320 | 2008-10-14 |
| 1932356284 | Gerard Joseph Ventura | Dentist | 21 Montauk Ave., Suite 102, New London, CT 06320 | 2008-08-19 |
| Find all providers in zip 06320 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598068348 | Malvin Charles Ware Sr. | Specialist | 40 Orchard St, New London, CT 06320-4818 | 2010-12-17 |
| 1912195918 | Niloufar Mobashery | Specialist | 50 Pequot Ave, Ms 6025-b3125, New London, CT 06320-5410 | 2007-10-04 |
| 1174617419 | Alan Jay Greenwald | Specialist | 268 Montauk Ave, New London, CT 06320-4712 | 2006-10-03 |
| 1871575696 | Robert M Spitz | Specialist | 342 Montauk Ave, New London, CT 06320-4706 | 2005-11-17 |
| 1053319624 | Anthony Dennis Quinn | Specialist | 3 Shaws Cv, Suite 206, New London, CT 06320-4952 | 2005-07-08 |
| 1790783264 | Cynthia Curioso-uy | Specialist | 125 Shaw St, New London, CT 06320-4900 | 2005-07-08 |
| 1891793592 | Joseph Oconnell | Specialist | 415 Ocean Ave, New London, CT 06320-4716 | 2005-07-07 |
| 1447409628 | Tu Nguyen | Specialist | 50 Pequot Ave, New London, CT 06320-5410 | 2008-09-12 |
| 1972772556 | Sepehr Sajjad | Specialist | 59 Fair Harbour Pl, New London, CT 06320-4739 | 2008-02-27 |
| 1720273741 | Digestive Disease Associates | Specialist | 268 Montauk Ave, New London, CT 06320-4712 | 2007-09-12 |
| Find all providers in NEW LONDON | ||||
| City | NEW LONDON |
| Zip Code | 06320 |
Please comment or provide details below to improve the information on DR. MICHAEL M DEREN.
| 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.