Provider Demographics
NPI:1316475593
Name:ENG, DERRICK (DO)
Entity type:Individual
Prefix:DR
First Name:DERRICK
Middle Name:
Last Name:ENG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:DERRICK
Other - Middle Name:
Other - Last Name:ENG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:7125 ORCHARD LAKE RD STE 316
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3629
Mailing Address - Country:US
Mailing Address - Phone:248-847-4847
Mailing Address - Fax:
Practice Address - Street 1:51 ATLANTIC AVE FL 100
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-2741
Practice Address - Country:US
Practice Address - Phone:866-607-2308
Practice Address - Fax:248-855-5455
Is Sole Proprietor?:No
Enumeration Date:2017-05-31
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY311665207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program