Healthcare Provider Details

I. General information

NPI: 1447227368
Provider Name (Legal Business Name): VALLEY HEALTH MEDICAL GROUP, NJ-PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 WASHINGTON AVE
DUMONT NJ
07628-3697
US

IV. Provider business mailing address

15 ESSEX RD 5TH FLOOR
PARAMUS NJ
07652-1451
US

V. Phone/Fax

Practice location:
  • Phone: 201-387-7055
  • Fax: 201-387-8605
Mailing address:
  • Phone: 201-291-6120
  • Fax: 201-291-6129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD KEENAN
Title or Position: VP FINANCE/CHIEF FINANCIAL OFFICER
Credential:
Phone: 201-291-6188