Provider Demographics
NPI:1821226945
Name:OLDENHAGE, DAVID GEORGE (BS, LMT, NCBTMB)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:GEORGE
Last Name:OLDENHAGE
Suffix:
Gender:M
Credentials:BS, LMT, NCBTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 PHILLIPS HILL RD
Mailing Address - Street 2:BUILDING 1
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-4132
Mailing Address - Country:US
Mailing Address - Phone:845-634-8822
Mailing Address - Fax:845-634-8823
Practice Address - Street 1:180 PHILLIPS HILL RD
Practice Address - Street 2:BUILDING 1
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-4132
Practice Address - Country:US
Practice Address - Phone:845-634-8822
Practice Address - Fax:845-634-8823
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022500174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist