Basic Information
| Provider Information | |||||||||
| NPI: | 1437208642 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VALLEY EAR, NOSE AND THROAT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 215 | ||||||||
| Address2: | |||||||||
| City: | JEFFERSON VALLEY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105350215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9142457700 | ||||||||
| FaxNumber: | 9142457836 | ||||||||
| Practice Location | |||||||||
| Address1: | 3630 HILL BLVD | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | JEFFERSON VALLEY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105351502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9142457700 | ||||||||
| FaxNumber: | 9142457836 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SIGLOCK | ||||||||
| AuthorizedOfficialFirstName: | TIMOTHY | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9142457700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 165043 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.