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General NPI Number Information
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NPI Number | 1801864673
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Entity Type | Organization
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Legal Business Name | VALLEY VASCULAR IMAGING
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Dates
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Enumeration Date | 03/09/2006
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Last Update Date | 06/22/2012
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Provider Practice Location Address
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Address Line | 540 PIERCE ST
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City | KINGSTON
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State | PA
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Zip | 18704-5751
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Country | US
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Telephone | 570-718-0101
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Fax |
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Provider Business Mailing Address
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Address Line | 540 PIERCE ST
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City | KINGSTON
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State | PA
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Zip | 18704-5751
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Country | US
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Telephone | 570-718-0101
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRIAN MARIEN
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Credential | M.D.
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Telephone | 570-718-0101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | PA
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