1336702331 NPI number — VALLEY URGENT CARE

Table of content: (NPI 1336702331)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336702331 NPI number — VALLEY URGENT CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALLEY URGENT CARE
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:
1336702331
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18 WEST RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLEASANT VALLEY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12569-7923
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-635-1590
Provider Business Mailing Address Fax Number:
845-223-8248

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18 WEST RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLEASANT VALLEY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12569-7923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-635-1590
Provider Business Practice Location Address Fax Number:
845-223-8248
Provider Enumeration Date:
04/16/2019

Additional Information

Authorized Official

Authorized Official Last Name:
FAKHOURI
Authorized Official First Name:
ZEIAD
Authorized Official Middle Name:
ABRAHAM
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
845-635-1590

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1598947194 . This is a "ALL INSURANCES" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1821584426 . This is a "ALL INSURANCES" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com