Provider Demographics
NPI:1457651614
Name:DOUGLAS J. VAN DER HEIDE, M.D. LLP
Entity Type:Organization
Organization Name:DOUGLAS J. VAN DER HEIDE, M.D. LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:VAN DER HEIDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-920-5228
Mailing Address - Street 1:10 E 85TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0412
Mailing Address - Country:US
Mailing Address - Phone:212-920-5228
Mailing Address - Fax:
Practice Address - Street 1:7 E 85TH ST APT B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0442
Practice Address - Country:US
Practice Address - Phone:212-920-5228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1312302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty