Provider Demographics
NPI:1972676401
Name:DAVID D. VANSLOOTEN,M.D.,P.A.
Entity Type:Organization
Organization Name:DAVID D. VANSLOOTEN,M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:D
Authorized Official - Last Name:VAN SLOOTEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-261-6222
Mailing Address - Street 1:99 KINDERKAMACK RD STE 307
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-3021
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5201608Medicaid
NJ5201608Medicaid