Healthcare Provider Details

I. General information

NPI: 1457626558
Provider Name (Legal Business Name): VALLEY PHYSICIAN SERVICES, NY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2012
Last Update Date: 03/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 N VAN DIEN AVE
RIDGEWOOD NJ
07450-2726
US

IV. Provider business mailing address

PO BOX 8500-7402
PHILADELPHIA PA
19178-0001
US

V. Phone/Fax

Practice location:
  • Phone: 201-432-7837
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State

VIII. Authorized Official

Name: AUDREY MEYERS
Title or Position: CEO
Credential:
Phone: 201-447-8021