Provider Demographics
NPI:1215359872
Name:ROBERT J. VAN DER LEEST MD, INC.
Entity Type:Organization
Organization Name:ROBERT J. VAN DER LEEST MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDERLEEST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-324-9135
Mailing Address - Street 1:800 CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-5317
Mailing Address - Country:US
Mailing Address - Phone:650-324-9135
Mailing Address - Fax:
Practice Address - Street 1:800 E BROWARD BLVD
Practice Address - Street 2:SUITE 507
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-2008
Practice Address - Country:US
Practice Address - Phone:954-736-4331
Practice Address - Fax:954-763-4775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-15
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1639254394OtherNPPES