Healthcare Provider Details

I. General information

NPI: 1992820930
Provider Name (Legal Business Name): VALSA MADHAVA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 E 40TH ST RM 201
NEW YORK NY
10016-0408
US

IV. Provider business mailing address

15 E 40TH ST RM 201
NEW YORK NY
10016-0408
US

V. Phone/Fax

Practice location:
  • Phone: 646-397-5988
  • Fax:
Mailing address:
  • Phone: 646-397-5988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number190822
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number190822-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: