Provider Demographics
NPI:1316602311
Name:VALOY, ROBERTO JR
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:VALOY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3680 ROUTE 44
Mailing Address - Street 2:
Mailing Address - City:MILLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:12545-5816
Mailing Address - Country:US
Mailing Address - Phone:845-453-9991
Mailing Address - Fax:
Practice Address - Street 1:3680 ROUTE 44
Practice Address - Street 2:
Practice Address - City:MILLBROOK
Practice Address - State:NY
Practice Address - Zip Code:12545-5816
Practice Address - Country:US
Practice Address - Phone:845-453-9991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY337226-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY738221073OtherDRIVERS LICENSE