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General NPI Number Information
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NPI Number | 1457651614
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Entity Type | Organization
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Legal Business Name | DOUGLAS J. VAN DER HEIDE, M.D. LLP
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Dates
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Enumeration Date | 10/21/2010
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Last Update Date | 10/21/2010
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Provider Practice Location Address
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Address Line | 7 E 85TH ST APT B
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City | NEW YORK
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State | NY
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Zip | 10028-0442
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Country | US
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Telephone | 212-920-5228
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Fax |
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Provider Business Mailing Address
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Address Line | 10 E 85TH ST
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City | NEW YORK
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State | NY
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Zip | 10028-0412
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Country | US
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Telephone | 212-920-5228
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DOUGLAS JOHN VAN DER HEIDE
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Credential | MD
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Telephone | 212-920-5228
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 131230
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License Number State | NY
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