Healthcare Provider Details

I. General information

NPI: 1801532072
Provider Name (Legal Business Name): LANAE VROEGINDEWEY DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2022
Last Update Date: 05/10/2022
Certification Date: 05/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5010 STATE HIGHWAY 30
AMSTERDAM NY
12010-7532
US

IV. Provider business mailing address

PO BOX 332
BROADALBIN NY
12025-0332
US

V. Phone/Fax

Practice location:
  • Phone: 518-842-2340
  • Fax:
Mailing address:
  • Phone: 973-618-6770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX013600-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: