Mia Deritis

Physician Assistant · Pennington, NJ

Individual Active NPI

NPI number 1073063012

Practice location

1 Capital Way
Pennington, NJ 08534-2520
Phone
(800) 637-2374

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NPI record

NPI
1073063012
Entity type
Individual (Type 1)
Enumeration date
October 13, 2016
Last updated
December 9, 2024
Certified
December 9, 2024
Sole proprietor
No

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Physician Assistant Primary 363A00000X 25MP00518400 NJ
Medical Physician Assistant 363AM0700X 25MP00518400 NJ

Other practice locations (2)

  • 1925 Pacific Ave, Atlantic City, NJ 08401-6713 · (609) 449-4373
  • 2 Capital Way Ste 456, Pennington, NJ 08534-2521 · (609) 537-7300

About Mia Deritis

Mia Deritis is a healthcare provider registered in the NPI registry with the primary taxonomy Physician Assistant (code 363A00000X). The practice location is 1 Capital Way, Pennington, NJ 08534-2520. The NPI number 1073063012 was assigned on October 13, 2016 and the record was last updated on December 9, 2024.

Mia Deritis lists 2 licenses in the registry: #25MP00518400 (NJ) for Physician Assistant; #25MP00518400 (NJ) for Medical Physician Assistant. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of Mia Deritis?

The NPI number is 1073063012.

What is the phone number of Mia Deritis?

The phone number listed for the practice location is (800) 637-2374.

Where is Mia Deritis located?

1 Capital Way, Pennington, NJ 08534-2520.

What is the taxonomy code for Mia Deritis?

The primary taxonomy code is 363A00000X – Physician Assistant; 1 more listed above.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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