Provider Demographics
NPI:1790745131
Name:VANKLEUNEN, ROSS C (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:C
Last Name:VANKLEUNEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 STOWE RD
Mailing Address - Street 2:STE 6
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-2582
Mailing Address - Country:US
Mailing Address - Phone:914-737-5416
Mailing Address - Fax:914-737-5935
Practice Address - Street 1:2 STOWE RD
Practice Address - Street 2:STE 6
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10566-2582
Practice Address - Country:US
Practice Address - Phone:914-737-5416
Practice Address - Fax:914-737-5935
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0055311213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01952345Medicaid
050351OtherAMERIHEALTH
719066OtherMVP
P1871060OtherOXFORD
5013105002OtherCIGNA
6201691OtherGHI
2C6242OtherHEALTHNET
PA9901OtherBLUE CROSS
NY01952345Medicaid
U74708Medicare UPIN
NYPA9901Medicare ID - Type Unspecified