| Doctor Name: | J DEREK BREDERSON |
| NPI Number: | 1790063162 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | FNP |
| License Number: | 336768 |
| Business Practice Address: | 60 Main St Port Byron, NY - 131400359 |
| Business Phone Number: | 3157769700 |
| Business Fax Number: | 3157769701 |
| Mailing Address: | 14 Maiden Ln, PENN YAN |
| State: | NY |
| Postal Code: | 145271208 |
| Phone Number: | 3155319102 |
| Fax Number: | 3155319103 |
| NPI Enumeration Date: | 08/02/2011 |
| NPI Last Update Date: | 02/14/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 336768 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |