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General NPI Number Information
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NPI Number | 1225421407
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Entity Type | Organization
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Legal Business Name | VAN UDEN CENTER
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Dates
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Enumeration Date | 03/11/2015
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Last Update Date | 03/11/2015
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Provider Practice Location Address
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Address Line | 9859 CORONA AVE
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City | CORONA
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State | NY
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Zip | 11368-2783
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Country | US
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Telephone | 347-858-4356
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Fax | 800-734-0709
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Provider Business Mailing Address
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Address Line | 60 LATOURETTE LN
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City | STATEN ISLAND
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State | NY
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Zip | 10314-6363
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Country | US
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Telephone | 347-858-1768
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. ALFONSO VAN UDEN
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Credential | N.D.
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Telephone | 800-734-0709
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ND100185 FEDERAL LIC
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License Number State |
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