Provider Demographics
NPI:1326845009
Name:VANDENBERG, ANAFAYE (RDA)
Entity type:Individual
Prefix:
First Name:ANAFAYE
Middle Name:
Last Name:VANDENBERG
Suffix:
Gender:
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 WALNUT LN
Mailing Address - Street 2:
Mailing Address - City:KINNELON
Mailing Address - State:NJ
Mailing Address - Zip Code:07405-2025
Mailing Address - Country:US
Mailing Address - Phone:201-745-4244
Mailing Address - Fax:
Practice Address - Street 1:21 WALNUT LN
Practice Address - Street 2:
Practice Address - City:KINNELON
Practice Address - State:NJ
Practice Address - Zip Code:07405-2025
Practice Address - Country:US
Practice Address - Phone:201-745-4244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver