Healthcare Provider Details

I. General information

NPI: 1669434502
Provider Name (Legal Business Name): VALLEY NEUROLOGICAL SURGERY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 07/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 STAFFORD ST SUITE 264
SPRINGFIELD MA
01104-3581
US

IV. Provider business mailing address

PO BOX 789
LUDLOW MA
01056-0789
US

V. Phone/Fax

Practice location:
  • Phone: 413-827-8800
  • Fax: 413-827-8811
Mailing address:
  • Phone: 413-509-1000
  • Fax: 413-509-1003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number71211
License Number StateMA

VIII. Authorized Official

Name: THOMAS S KAYE
Title or Position: OWNER
Credential: MD
Phone: 413-827-8800