Provider Demographics
NPI:1710479571
Name:ROSS C VAN KLEUNEN
Entity Type:Organization
Organization Name:ROSS C VAN KLEUNEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:C
Authorized Official - Last Name:VAN KLEUNEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:914-737-5416
Mailing Address - Street 1:939 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-2008
Mailing Address - Country:US
Mailing Address - Phone:914-737-5416
Mailing Address - Fax:914-737-5935
Practice Address - Street 1:939 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10566-2008
Practice Address - Country:US
Practice Address - Phone:914-737-5416
Practice Address - Fax:914-737-5935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005531-1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty