Provider Demographics
NPI:1134314867
Name:VAN MILDERS, MARTINE LILIANE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARTINE
Middle Name:LILIANE
Last Name:VAN MILDERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 JOHNSTON DR
Mailing Address - Street 2:
Mailing Address - City:WATCHUNG
Mailing Address - State:NJ
Mailing Address - Zip Code:07069-6409
Mailing Address - Country:US
Mailing Address - Phone:908-727-2700
Mailing Address - Fax:908-757-2954
Practice Address - Street 1:1841 BROADWAY
Practice Address - Street 2:4TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-7603
Practice Address - Country:US
Practice Address - Phone:212-541-8196
Practice Address - Fax:212-333-5444
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012650103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical