Healthcare Provider Details

I. General information

NPI: 1053411058
Provider Name (Legal Business Name): VALENTIN L FAGEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

248 S BROADWAY
PENNSVILLE NJ
08070
US

IV. Provider business mailing address

248 S BROADWAY
PENNSVILLE NJ
08070
US

V. Phone/Fax

Practice location:
  • Phone: 856-678-8118
  • Fax: 856-678-8130
Mailing address:
  • Phone: 856-678-8118
  • Fax: 856-678-8130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25MA04174100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: