Organization
DOUGLAS J VANDER HEIDE MDPC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS J VAN DER HEIDE (SOLE PROPRIETER)
(212) 772-6443
Entity
Organization
Contact information
Practice address
7 E 85TH ST APT G, NEW YORK, NY 10028-0440
(212) 772-6443
Mailing address
10 E 85TH ST, 5A, NYC, NY 10028-0412
(212) 772-6443
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
Primary
131230
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00509673
—
NY
Enumeration date
03/15/2006
Last updated
02/01/2010
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