Provider Demographics
NPI:1619677986
Name:VAN DYCK, VIVIAN EFFIE (HOME CARE AGENT)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:EFFIE
Last Name:VAN DYCK
Suffix:
Gender:F
Credentials:HOME CARE AGENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 ALDEN ST APT 384
Mailing Address - Street 2:
Mailing Address - City:WALLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07057-2078
Mailing Address - Country:US
Mailing Address - Phone:201-580-0300
Mailing Address - Fax:
Practice Address - Street 1:271 ALDEN ST APT 384
Practice Address - Street 2:
Practice Address - City:WALLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07057-2078
Practice Address - Country:US
Practice Address - Phone:201-580-0300
Practice Address - Fax:973-778-0884
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide