Provider Demographics
NPI:1639251218
Name:VAN SLOOTEN, DAVID DENNIS (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:DENNIS
Last Name:VAN SLOOTEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 KINDERKAMACK RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:ORADELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07649-1600
Mailing Address - Country:US
Mailing Address - Phone:201-261-6222
Mailing Address - Fax:201-261-4411
Practice Address - Street 1:99 KINDERKAMACK RD STE 307
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-3021
Practice Address - Country:US
Practice Address - Phone:201-261-6222
Practice Address - Fax:201-261-4411
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA0475562084N0600X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
130007265OtherRAILROAD MEDICARE
6704803OtherCIGNA
NJ1707507Medicaid
NY01871778Medicaid
2K9180OtherHEALTHNET
130007265OtherRAILROAD MEDICARE
6704803OtherCIGNA