Provider Demographics
NPI:1346622115
Name:VANLARE MEDICAL PRACTICE PLLC
Entity Type:Organization
Organization Name:VANLARE MEDICAL PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:METZ
Authorized Official - Last Name:VANLARE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-978-5241
Mailing Address - Street 1:PO BOX 25272
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:14425-0272
Mailing Address - Country:US
Mailing Address - Phone:914-200-3782
Mailing Address - Fax:
Practice Address - Street 1:460 BEECHMONT DR
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10804-4613
Practice Address - Country:US
Practice Address - Phone:914-200-3782
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-29
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty