Provider Demographics
NPI:1346529740
Name:VANDE VEN, HEATHER ANNE (DO)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANNE
Last Name:VANDE VEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 GOLD ST
Mailing Address - Street 2:3211
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-3055
Mailing Address - Country:US
Mailing Address - Phone:970-219-1762
Mailing Address - Fax:
Practice Address - Street 1:150 55TH STREETN
Practice Address - Street 2:LUTHERAN MEDICAL CENTER
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220
Practice Address - Country:US
Practice Address - Phone:718-630-7351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY15161208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery