Provider Demographics
NPI:1740365543
Name:VANKALMTHOUT, LEONARD H (DC)
Entity type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:H
Last Name:VANKALMTHOUT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-2730
Mailing Address - Country:US
Mailing Address - Phone:631-567-2424
Mailing Address - Fax:631-256-0012
Practice Address - Street 1:200 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11782-2730
Practice Address - Country:US
Practice Address - Phone:631-567-2424
Practice Address - Fax:631-256-0012
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007087111NS0005X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX54091Medicare PIN