Provider Demographics
NPI:1447227368
Name:VALLEY HEALTH MEDICAL GROUP, NJ-PC
Entity Type:Organization
Organization Name:VALLEY HEALTH MEDICAL GROUP, NJ-PC
Other - Org Name:VALLEY HEALTH MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCE/CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:KEENAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-291-6188
Mailing Address - Street 1:15 ESSEX RD
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-1451
Mailing Address - Country:US
Mailing Address - Phone:201-291-6120
Mailing Address - Fax:201-291-6129
Practice Address - Street 1:40 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:DUMONT
Practice Address - State:NJ
Practice Address - Zip Code:07628-3697
Practice Address - Country:US
Practice Address - Phone:201-387-7055
Practice Address - Fax:201-387-8605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ894072Medicare ID - Type UnspecifiedMEDICARE GROUP PROVIDER #