Provider Demographics
NPI:1609195502
Name:VAN DONGEN, DANIEL J
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:VAN DONGEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 N FLAGLER DR APT 214
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-6594
Mailing Address - Country:US
Mailing Address - Phone:786-375-7019
Mailing Address - Fax:
Practice Address - Street 1:3107 NE 40TH CT
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-6413
Practice Address - Country:US
Practice Address - Phone:954-454-2345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-18
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT13694225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist