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General NPI Number Information
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NPI Number | 1508606997
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Entity Type | Organization
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Legal Business Name | SPRING VALLEY WELLNESS LLC
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Dates
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Enumeration Date | 05/31/2024
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Last Update Date | 05/31/2024
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Provider Practice Location Address
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Address Line | 175 ROUTE 59 STE 170
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City | SPRING VALLEY
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State | NY
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Zip | 10977-5231
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Country | US
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Telephone | 973-747-5217
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Fax | 973-396-8832
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Provider Business Mailing Address
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Address Line | 400 RELLA BLVD STE 165
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City | SUFFERN
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State | NY
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Zip | 10901-8114
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING OFFICER
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Name | MR. LEO ESCOBAR
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Credential |
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Telephone | 908-202-5690
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QB0400X
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Taxonomy Name | Birthing Clinic/Center
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License Number |
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License Number State | NULL
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Taxonomy #2
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Taxonomy Code | 261QF0050X
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Taxonomy Name | Non-Surgical Family Planning Clinic/Center
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License Number |
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License Number State | NULL
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Taxonomy #3
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State | NULL
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Taxonomy #4
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Taxonomy Code | 163WC1500X
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Taxonomy Name | Community Health Registered Nurse
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License Number |
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License Number State | NULL
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Taxonomy #5
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State | NULL
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