Individual
MR. JOSEPH N DERAVILLE SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
557 NEW DOVER RD, ISELIN, NJ 08830-1127
(732) 388-4128
Mailing address
557 NEW DOVER RD, ISELIN, NJ 08830-1127
(732) 388-4128
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
25MP00142700
NJ
Other
Enumeration date
08/27/2010
Last updated
08/27/2010
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