Provider Demographics
NPI:1679587356
Name:VUYLSTEKE, PHILIPPE (MD)
Entity Type:Individual
Prefix:
First Name:PHILIPPE
Middle Name:
Last Name:VUYLSTEKE
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 1:110 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-5674
Mailing Address - Country:US
Mailing Address - Phone:508-941-7000
Mailing Address - Fax:508-894-0412
Practice Address - Street 1:110 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-5674
Practice Address - Country:US
Practice Address - Phone:508-941-7000
Practice Address - Fax:508-894-0412
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225716207Q00000X
MA260995207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10066238OtherCDPHP
NY361196OtherMVP HEALTHPLAN
NY000402893001OtherBSH NE NY
NY0231271Medicaid
NYDD2634Medicare ID - Type Unspecified
NYH71792Medicare UPIN