Healthcare Provider Details

I. General information

NPI: 1811050289
Provider Name (Legal Business Name): LILLIAN LIDUVINA VALLE NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 AMSTERDAM AVENUE ST LUKES ROOSEVELT HOSPITAL CENTER MEDICAL CLINIC
NEW YORK NY
10025
US

IV. Provider business mailing address

100 WEST 105TH STREET #D3
NEW YORK NY
10025
US

V. Phone/Fax

Practice location:
  • Phone: 212-523-4415
  • Fax: 212-523-4554
Mailing address:
  • Phone: 212-523-4415
  • Fax: 212-523-4554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number2834171
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF3002971
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: