Healthcare Provider Details

I. General information

NPI: 1235754219
Provider Name (Legal Business Name): HAROLDO JOSE VALBUENA-C. RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2020
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4404 QUEENS BLVD FL 2
SUNNYSIDE NY
11104-2406
US

IV. Provider business mailing address

6120 WOODSIDE AVE LOWR LEVEL
WOODSIDE NY
11377-3577
US

V. Phone/Fax

Practice location:
  • Phone: 718-706-1663
  • Fax:
Mailing address:
  • Phone: 718-672-1705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number778127-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: