Provider Demographics
NPI:1013022805
Name:VANDERHOOF, M IRENE (MD)
Entity Type:Individual
Prefix:
First Name:M
Middle Name:IRENE
Last Name:VANDERHOOF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:NY
Mailing Address - Zip Code:13421-7111
Mailing Address - Country:US
Mailing Address - Phone:315-363-4070
Mailing Address - Fax:315-363-8768
Practice Address - Street 1:1145 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421-7111
Practice Address - Country:US
Practice Address - Phone:315-363-4070
Practice Address - Fax:315-363-8768
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY188796208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01487874Medicaid