Provider Demographics
NPI:1235467663
Name:VALLEY MEDICAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:VALLEY MEDICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:L
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-565-1717
Mailing Address - Street 1:329 WINDSOR HWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-6909
Mailing Address - Country:US
Mailing Address - Phone:845-565-1717
Mailing Address - Fax:845-565-0461
Practice Address - Street 1:329 WINDSOR HWY
Practice Address - Street 2:SUITE 200
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-6909
Practice Address - Country:US
Practice Address - Phone:845-565-1717
Practice Address - Fax:845-565-0461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY159421-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
YP081OtherOXFORD HEALTH PLAN
NY01237838Medicaid
10034080OtherCDPHP
68F723OtherEMPIRE
68F723OtherEMPIRE