Provider Demographics
NPI:1124469432
Name:VANHORN, PIETER SCHUYLER (MPAS, RPA-C)
Entity type:Individual
Prefix:MR
First Name:PIETER
Middle Name:SCHUYLER
Last Name:VANHORN
Suffix:
Gender:M
Credentials:MPAS, RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 WOODSTOCK RD
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:14069-9631
Mailing Address - Country:US
Mailing Address - Phone:716-462-4488
Mailing Address - Fax:
Practice Address - Street 1:6 FOUNTAIN PLZ
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-2211
Practice Address - Country:US
Practice Address - Phone:716-308-2557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012783363A00000X
PAOA002466363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant