Healthcare Provider Details

I. General information

NPI: 1457589814
Provider Name (Legal Business Name): VALLEY WEST MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2009
Last Update Date: 10/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 VALLEY BLVD
WOOD RIDGE NJ
07075-1236
US

IV. Provider business mailing address

245 VALLEY BLVD
WOOD RIDGE NJ
07075-1236
US

V. Phone/Fax

Practice location:
  • Phone: 201-438-5500
  • Fax: 201-438-3363
Mailing address:
  • Phone: 201-438-5500
  • Fax: 201-438-3363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NICHOLAS T PECORELLI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 201-438-5500