Provider Demographics
NPI:1801587415
Name:VANLUVENDER, TED (PA)
Entity type:Individual
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First Name:TED
Middle Name:
Last Name:VANLUVENDER
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Gender:M
Credentials:PA
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Mailing Address - Street 1:169 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-4198
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3101 SHIPPERS RD STE 202
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-2082
Practice Address - Country:US
Practice Address - Phone:607-754-5342
Practice Address - Fax:607-754-5508
Is Sole Proprietor?:No
Enumeration Date:2023-05-16
Last Update Date:2023-10-12
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant