1588553788 NPI number — VALLEY OAKS NP IN PSYCHIATRY PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588553788 NPI number — VALLEY OAKS NP IN PSYCHIATRY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALLEY OAKS NP IN PSYCHIATRY PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588553788
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
138 OLIVER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VALLEY STREAM
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11580-1626
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-478-9200
Provider Business Mailing Address Fax Number:
516-812-0021

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
405 RXR PLAZA
Provider Second Line Business Practice Location Address:
STE 405E, 4TH FLOOR
Provider Business Practice Location Address City Name:
UNIONDALE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11556
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-478-9200
Provider Business Practice Location Address Fax Number:
516-812-0021
Provider Enumeration Date:
07/01/2025

Additional Information

Authorized Official

Authorized Official Last Name:
NORBRUN
Authorized Official First Name:
RUTHE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
347-358-1297

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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