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MS. DERLY M HEREDIA P.A.
NPI 1316126287
Physician Assistant - Medical in Elmhurst, NY

Active since October 29, 2007PECOS Enrolled
4028 82ND ST, 2ND FLOOR, ELMHURST, NY 11373(718) 478-0338(718) 478-6050 Get Directions Write a Review

NPPES record last updated: October 29, 2007. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Ms. Derly M Heredia P.a. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MS. DERLY M HEREDIA P.A. (NPI 1316126287) is an individual medical provider in Elmhurst, New York, licensed in New York (011032) and active in the NPI registry since October 2007. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1316126287
Entity TypeIndividualFemale
Primary Taxonomy363AM0700X
Provider Legal NameMS. DERLY M HEREDIACredential: P.A.
Location Address4028 82ND ST, 2ND FLOORElmhurst, NY 11373-1305
Mailing Address4028 82nd St, 2nd FloorElmhurst, NY 11373-1305 · (718) 478-0338 · Fax (718) 478-6050
Phone(718) 478-0338
Fax(718) 478-6050
Sole ProprietorYes
Enumeration DateOctober 29, 2007
✔ NPI 1316126287 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AM0700X
License✔ Licensed in NY · 011032
4028 82ND ST, Elmhurst, NY 11373
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Ms. Derly M Heredia P.a. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

EYES & OPTICS ELMHURST INC
Eyewear Supplier
4028 82ND ST
ELMHURST, NY 11373
Queens County (718) 639-9225
GREGORY M LOPEZ ODPC
Optometrist
4028 82ND ST
ELMHURST, NY 11373
Queens County (718) 639-9225

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Derly Heredia's NPI number?

The NPI number for Derly Heredia is 1316126287. It was assigned to this individual provider in the NPPES registry on October 29, 2007.

Where is Derly Heredia located?

Derly Heredia practices at 4028 82nd St 2nd Floor, Elmhurst, NY 11373. The listed phone number is (718) 478-0338.

What is Derly Heredia's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Is Derly Heredia enrolled in Medicare?

Yes. Derly Heredia is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Derly Heredia was last updated on October 29, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.