Dejong, Alida Anne

Dejong, Alida Anne is an individual health care provider with primary practice located at 1045 James St , Syracuse NY 13203-2730. She recently has 3 registered licenses in different health care specialties including Nursing Service Providers / General Practice, Physician Assistants & Advanced Practice Nursing Providers / Adult Health, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Family is her primary health care specialty. Dejong, Alida Anne can be contacted via phone (315) 472-4471.

Contact Information

Primary practice address
1045 James St Syracuse NY 13203-2730
Phone: (315) 472-4471
Fax: (315) 472-1759
Website:
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Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / General Practice 163WG0000X 482368-1 New York
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 363LA2200X F302146-1 New York
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X F333173-1 New York

Profile Details

NPI number 1013912153
LBN Legal business name Dejong, Alida Anne
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 16th, 2005
Last updated Dec 1st, 2015 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1013912153 NPPES
New York MEDICAID 02629216

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