Vandevender, Jeremy C

Vandevender, Jeremy C is an individual health care provider with primary practice located at 4434 Amboy Rd , Staten Island NY 10312-3866. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as his primary health care specialty. Vandevender, Jeremy C can be contacted via phone (718) 227-7015.

Contact Information

Primary practice address
4434 Amboy Rd Staten Island NY 10312-3866
Phone: (718) 227-7015
Fax: (718) 227-6411
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X 021302-1 New York
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X 40QA00972700 New Jersey

Profile Details

NPI number 1487691416
LBN Legal business name Vandevender, Jeremy C
Credentials Physical Therapist (PT)
Entity Individual
Sole proprietor 1 No
Enumeration date May 31st, 2006
Last updated Nov 10th, 2009 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1487691416 NPPES
New York MEDICAID 02584283

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