Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 306508 | NY |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | MDRE.ML.60979056 | WA |
NPI | 1043868219 |
---|---|
Provider Name | Samuel Karel Van De Velde |
First Address | New York, NY 10032-3720 |
Second Address | Brooklyn, NY 11215 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2019 |
Last Update Date | 05/04/2021 |