Provider Demographics
NPI:1316186844
Name:VAN DIJK, HUGO PETER (PT, MBA)
Entity Type:Individual
Prefix:MR
First Name:HUGO
Middle Name:PETER
Last Name:VAN DIJK
Suffix:
Gender:M
Credentials:PT, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 SHORE RD
Mailing Address - Street 2:APARTMENT 4
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-4257
Mailing Address - Country:US
Mailing Address - Phone:718-440-1979
Mailing Address - Fax:
Practice Address - Street 1:215 SHORE RD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-4257
Practice Address - Country:US
Practice Address - Phone:718-440-1979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-06
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015788174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist