Healthcare Provider Details

I. General information

NPI: 1386799591
Provider Name (Legal Business Name): THE VAN OST INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E PALISADE AVE
ENGLEWOOD NJ
07631-3013
US

IV. Provider business mailing address

150 E PALISADE AVE
ENGLEWOOD NJ
07631-3013
US

V. Phone/Fax

Practice location:
  • Phone: 201-569-6667
  • Fax: 201-569-7504
Mailing address:
  • Phone: 201-569-6667
  • Fax: 201-569-7504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: GWEN RHODE
Title or Position: BUSINESS MANAGER
Credential:
Phone: 201-569-6667