1740553122 NPI number — RAMON VALLARINO JR, MDPC

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 1740553122 NPI number — RAMON VALLARINO JR, MDPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAMON VALLARINO JR, MDPC
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:
1740553122
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3704 91ST ST
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
JACKSON HEIGHTS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11372-7914
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-396-1742
Provider Business Mailing Address Fax Number:
718-396-3297

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
164 20TH STREET SUITE 2E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-396-1742
Provider Business Practice Location Address Fax Number:
718-396-3297
Provider Enumeration Date:
02/16/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TUFANO
Authorized Official First Name:
LORENA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
516-747-7780

Provider Taxonomy Codes

  • Taxonomy code: 261QR0400X , with the licence number:  205319 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01756041 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".