Healthcare Provider Details

I. General information

NPI: 1669689964
Provider Name (Legal Business Name): HONORA VALANE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

695 US HIGHWAY 46 SUITE 400A
FAIRFIELD NJ
07004-1592
US

IV. Provider business mailing address

PO BOX 4059
WAYNE NJ
07474-4059
US

V. Phone/Fax

Practice location:
  • Phone: 973-826-8080
  • Fax: 866-309-3354
Mailing address:
  • Phone: 973-894-1264
  • Fax: 888-972-6480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MA03498800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MA03498800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: