Provider Demographics
NPI:1568493088
Name:VANDERSLUIS, RALF W (MD)
Entity Type:Individual
Prefix:
First Name:RALF
Middle Name:W
Last Name:VANDERSLUIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1 E. NEW YORK AVE
Mailing Address - Street 2:4TH FLOOR ADMIN
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244
Mailing Address - Country:US
Mailing Address - Phone:609-653-3265
Mailing Address - Fax:609-926-4311
Practice Address - Street 1:649 SHORE RD
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2449
Practice Address - Country:US
Practice Address - Phone:609-365-6202
Practice Address - Fax:609-653-1925
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA082140002084N0400X
PAMD065571L2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0888541Medicaid
PA1016536590001Medicaid
PA102844PUMMedicare ID - Type Unspecified