Provider Demographics
NPI:1609082924
Name:VANDENBERG, ALINA MIRUNA (DPM)
Entity Type:Individual
Prefix:DR
First Name:ALINA
Middle Name:MIRUNA
Last Name:VANDENBERG
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 708
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:NJ
Mailing Address - Zip Code:07620-0708
Mailing Address - Country:US
Mailing Address - Phone:201-768-6788
Mailing Address - Fax:201-768-8097
Practice Address - Street 1:55 OLD TURNPIKE RD
Practice Address - Street 2:SUITE 507
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-2461
Practice Address - Country:US
Practice Address - Phone:201-768-6788
Practice Address - Fax:201-768-8097
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD002572213E00000X
NY004781213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist