Provider Demographics
NPI:1497851992
Name:DELLOCONO, VALERIE LYNN
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:LYNN
Last Name:DELLOCONO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4175 VETERANS MEMORIAL HWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-7639
Mailing Address - Country:US
Mailing Address - Phone:631-580-5200
Mailing Address - Fax:631-580-5222
Practice Address - Street 1:4 E JIMMIE LEEDS RD
Practice Address - Street 2:STE 3
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-4465
Practice Address - Country:US
Practice Address - Phone:609-748-4288
Practice Address - Fax:609-748-4282
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00725700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ051493Medicare ID - Type Unspecified