National Provider Identifier
Tiffany Derue
Tiffany Derue is listed in the NPPES registry with a primary specialty of Specialist in Newark, NY and a listed phone number of (315) 331-2086.
Profile Overview
- NPI
- 1629331020
- Provider Type
- Individual
- Primary Specialty
- Specialist
- Enumeration Date
- June 20, 2012
- Last Updated
- June 20, 2012
Practice Location
- 848 Peirson Ave
- Newark, NY 14513-9762
Phone: (315) 331-2086
Mailing Address
- 5748 Ridge RD
- Williamson, NY 14589-9717
Specialties
- Specialist (174400000X)
Full Record
- NPI
- 1629331020
- Entity Type
- Individual
- Last Name
- Derue
- First Name
- Tiffany
- Mailing Street Address
- 5748 Ridge RD
- Mailing City
- Williamson
- Mailing State
- NY
- Mailing ZIP Code
- 14589-9717
- Mailing Country
- US
- Practice Street Address
- 848 Peirson Ave
- Practice City
- Newark
- Practice State
- NY
- Practice ZIP Code
- 14513-9762
- Practice Country
- US
- Practice Phone
- (315) 331-2086
- Enumeration Date
- June 20, 2012
- Last Updated
- June 20, 2012
- Sex
- Female
- Sole Proprietor
- No
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Specialist (174400000X)