William Vanderwall, P.A.-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

014744 Issued in NY

Practice address

121 Dekalb Ave
Brooklyn, NY 11201-5425

Phone

(718) 250-8000

NPI assigned

Jul 5, 2011

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jamaica Hospital

  • Emergency Medical Services (Emergency Medicine) Physician
  • Jamaica, NY
  • NPI 1477505220
  Medicare reassignment NPD
• TBHC Physician Services PC

  • Surgery Physician
  • Brooklyn, NY
  • NPI 1417183963
  Medicare reassignment
• Jamaica Hospital

  • Skilled Nursing Facility
  • Jamaica, NY
  • NPI 1750516795
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1309824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1309824000000",
    "number": "1205123783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1288 1ST AVE APT 5FS",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100215568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 DEKALB AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112015425",
            "telephone_number": "718-250-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDERWALL",
        "first_name": "WILLIAM",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-07-05",
        "last_updated": "2011-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NY",
            "license": "014744",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Timothy Vanderslice, M.D.
• Vanderveer Pharmacy Inc.
• Vanderveer RX Inc
• Theresa Maria Vanderveer-Boyd, CSW
• Kristina Marie Vanderwall, COTA/L
• Kirk Vandyck
• Cecile Elizabeth Vanech, MA, PT
• Sara Vaneerde, LCSW
• Emanuel Vanegas, M.D.
• Johnny F Vanegas

• Surgical Physician Assistant in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Surgical Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.