1790745131 NPI number — DR. ROSS C VANKLEUNEN DPM

Table of content: DR. ROSS C VANKLEUNEN DPM (NPI 1790745131)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790745131 NPI number — DR. ROSS C VANKLEUNEN DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VANKLEUNEN
Provider First Name:
ROSS
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1790745131
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/20/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 STOWE RD
Provider Second Line Business Mailing Address:
STE 6
Provider Business Mailing Address City Name:
PEEKSKILL
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10566-2582
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-737-5416
Provider Business Mailing Address Fax Number:
914-737-5935

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 STOWE RD
Provider Second Line Business Practice Location Address:
STE 6
Provider Business Practice Location Address City Name:
PEEKSKILL
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10566-2582
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-737-5416
Provider Business Practice Location Address Fax Number:
914-737-5935
Provider Enumeration Date:
03/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  N0055311 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01952345 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 050351 . This is a "AMERIHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 719066 . This is a "MVP" identifier . This identifiers is of the category "OTHER".
  • Identifier: P1871060 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5013105002 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6201691 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2C6242 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: PA9901 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".




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