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General NPI Number Information
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NPI Number | 1447667126
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Entity Type | Organization
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Legal Business Name | VALENTINE PUBLIC HEALTH CONSULTANT AND CARE CENTER
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Dates
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Enumeration Date | 07/15/2014
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Last Update Date | 07/15/2014
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Provider Practice Location Address
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Address Line | 12 39TH ST
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City | IRVINGTON
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State | NJ
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Zip | 07111-1250
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Country | US
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Telephone | 862-944-4800
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Fax | 973-372-4421
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Provider Business Mailing Address
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Address Line | 5500 FLORIDA BLVD
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City | BATON ROUGE
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State | LA
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Zip | 70806-4133
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Country | US
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Telephone | 225-663-2445
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Fax | 225-663-2419
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. GARDY VALENTIN
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Credential | MD
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Telephone | 225-663-2445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD205405
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License Number State | LA
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