MEDICARE: DR. RUBI MODESTO VALERIO MD.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	230764	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578529590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUBI MODESTO VALERIO MD.

Provider Business Mailing Address
First Line	:	1650 GRAND CONCOURSE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10457
Country	:	US
Telephone Number	:	718-901-8918
Fax Number	:	718-901-8929

Provider Business Practice Location Address
First Line	:	1067 OGDEN AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10452
Country	:	US
Telephone Number	:	718-963-6551
Fax Number	:	718-963-6793

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	03/20/2013

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