Basic Information
| Provider Information | |||||||||
| NPI: | 1881977973 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VANDERBECK | ||||||||
| FirstName: | MANDY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | OT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 53 PASSAIC AVE | ||||||||
| Address2: | |||||||||
| City: | OGDENSBURG | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074391172 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 65 N SUSSEX ST | ||||||||
| Address2: | |||||||||
| City: | DOVER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 078013949 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9733615200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2011 | ||||||||
| LastUpdateDate: | 09/24/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 46TR00464200 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.