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General NPI Number Information
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NPI Number | 1720736705
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Entity Type | Organization
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Legal Business Name | VALHALLA MEDICS, LLC
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Dates
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Enumeration Date | 03/17/2022
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Last Update Date | 03/17/2022
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Provider Practice Location Address
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Address Line | 92-18 ROCKAWAY BEACH BLVD
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City | ROCKAWAY BEACH
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State | NY
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Zip | 11693
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Country | US
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Telephone | 516-266-6186
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Fax | 445-800-8689
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Provider Business Mailing Address
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Address Line | 92-18 ROCKAWAY BEACH BLVD
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City | ROCKAWAY BEACH
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State | NY
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Zip | 11693
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Country | US
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Telephone | 516-266-6186
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Fax | 445-800-8689
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Authorized Official
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Title or Position | CEO
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Name | MR. PHILIP D'AGOSTINO
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Credential |
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Telephone | 516-266-6186
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WI0500X
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Taxonomy Name | Infusion Therapy Registered Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 247ZC0005X
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Taxonomy Name | Clinical Laboratory Director (Non-physician)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 146N00000X
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Taxonomy Name | Basic Emergency Medical Technician
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License Number |
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License Number State |
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