Healthcare Provider Details

I. General information

NPI: 1891067617
Provider Name (Legal Business Name): VALLEY INTERVENTIONAL MEDICAL ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2012
Last Update Date: 04/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 MERRITT BLVD STE 107
FISHKILL NY
12524-2974
US

IV. Provider business mailing address

3001 PALM HARBOR BLVD STE A
PALM HARBOR FL
34683-1930
US

V. Phone/Fax

Practice location:
  • Phone: 727-474-0090
  • Fax:
Mailing address:
  • Phone: 727-474-0090
  • Fax: 727-474-0055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JANET R DEES
Title or Position: MANAGING MEMBER
Credential:
Phone: 727-474-0090