Healthcare Provider Details

I. General information

NPI: 1154470870
Provider Name (Legal Business Name): VALLEY PHYSICIAN SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 08/27/2013
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 11653
BELFAST ME
04915
US

V. Phone/Fax

Practice location:
  • Phone: 201-447-8517
  • Fax: 201-447-8491
Mailing address:
  • Phone: 201-291-6086
  • Fax: 201-291-6138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MARC GOLDSTEIN
Title or Position: PRESIDENT
Credential:
Phone: 201-291-6086