Basic Information
| Provider Information | |||||||||
| NPI: | 1154678951 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | VALLEY MANAGEMENT | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 305 W GRAND AVE | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | MONTVALE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076451813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2013918282 | ||||||||
| FaxNumber: | 2013918299 | ||||||||
| Practice Location | |||||||||
| Address1: | 305 W GRAND AVE | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | MONTVALE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076451813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2013918282 | ||||||||
| FaxNumber: | 2013918299 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2012 | ||||||||
| LastUpdateDate: | 08/10/2012 | ||||||||
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| AuthorizedOfficialLastName: | GAMBURG | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2013918282 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 25MA06745800 | NJ | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.