Provider Demographics
NPI:1912588534
Name:DECORA, DEREK PAUL
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:PAUL
Last Name:DECORA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1034 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1328
Mailing Address - Country:US
Mailing Address - Phone:914-509-4640
Mailing Address - Fax:
Practice Address - Street 1:298 NAT TURNER BLVD S
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-3074
Practice Address - Country:US
Practice Address - Phone:757-596-1900
Practice Address - Fax:757-591-8560
Is Sole Proprietor?:No
Enumeration Date:2021-04-15
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02233500225100000X
NY047136225100000X
VACP043129T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist