1710069133 NPI number — VAN DYK HEALTHCARE, INC.

Table of content: DR. COURTNEY LEIGH TOWNSEND PSYD (NPI 1932083375)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710069133 NPI number — VAN DYK HEALTHCARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VAN DYK HEALTHCARE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710069133
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/07/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
644 GOFFLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAWTHORNE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07506-3452
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-689-7991
Provider Business Mailing Address Fax Number:
973-304-2046

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
304 S VAN DIEN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIDGEWOOD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07450-5200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-689-7991
Provider Business Practice Location Address Fax Number:
201-445-9535
Provider Enumeration Date:
10/19/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MELCHIONDA
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
201-689-7991

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  060227 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)