Individual
WILLIAM VANDERWALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C
Contact information
Practice address
121 DEKALB AVE, BROOKLYN, NY 11201-5425
(718) 250-8000
Mailing address
1288 1ST AVE APT 5FS, NEW YORK, NY 10021-5568
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
014744
NY
Other
Enumeration date
07/05/2011
Last updated
07/05/2011
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