Healthcare Provider Details

I. General information

NPI: 1134173651
Provider Name (Legal Business Name): ALEXANDER G VANDEVELDE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 03/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 TREMONT AVE
EAST ORANGE NJ
07018-1023
US

IV. Provider business mailing address

385 TREMONT AVE
EAST ORANGE NJ
07018-1023
US

V. Phone/Fax

Practice location:
  • Phone: 973-676-1000
  • Fax:
Mailing address:
  • Phone: 973-676-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME13841
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: