Healthcare Provider Details

I. General information

NPI: 1013417708
Provider Name (Legal Business Name): ALLEYVALLEY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2018
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 W ROUTE 59
SPRING VALLEY NY
10977-5451
US

IV. Provider business mailing address

290 W ROUTE 59
SPRING VALLEY NY
10977-5451
US

V. Phone/Fax

Practice location:
  • Phone: 845-351-0300
  • Fax: 845-351-0323
Mailing address:
  • Phone: 845-351-0300
  • Fax: 845-351-0323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. SRULI OSTER
Title or Position: PRESIDENT
Credential:
Phone: 917-701-3618