Provider Demographics
NPI:1417531047
Name:VAN DYKE, HARRY J III (DPT, PT)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:J
Last Name:VAN DYKE
Suffix:III
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1377 MOTOR PKWY STE 307
Mailing Address - Street 2:
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-5258
Mailing Address - Country:US
Mailing Address - Phone:631-580-5200
Mailing Address - Fax:631-761-8306
Practice Address - Street 1:243 SPARTA AVE STE 2
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-1143
Practice Address - Country:US
Practice Address - Phone:973-512-3180
Practice Address - Fax:973-512-3280
Is Sole Proprietor?:No
Enumeration Date:2021-05-10
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist