Individual provider · Type 1 NPI

Grant Dale-Derks, DO

Student in an Organized Health Care Education/Training Program · Bronx, NY

NPI number 1386303550 Active

Practice location

4422 3rd Ave
Bronx, NY 10457-2545

Call (718) 960-9000 Map

Mailing address

333 Huguenot St Apt P112
New Rochelle, NY 10801-7350

Other practice locations

  • 1750 Independence Ave, Kansas City, MO 64106-1453 · (636) 541-8934

Specialties and licenses

TaxonomyCodeLicense
Student in an Organized Health Care Education/Training Program Primary 390200000XNone listed

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1386303550

Grant Dale-Derks, DO's National Provider Identifier is 1386303550, issued on Dec 14, 2021. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Bronx, NY. The record was last updated on Feb 18, 2026.