Provider Demographics
NPI:1548400856
Name:MOIRANGTHEM, VALENTINA (MD)
Entity Type:Individual
Prefix:
First Name:VALENTINA
Middle Name:
Last Name:MOIRANGTHEM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 SELWYN AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-7626
Mailing Address - Country:US
Mailing Address - Phone:718-239-8359
Mailing Address - Fax:718-579-3901
Practice Address - Street 1:1650 SELWYN AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-7626
Practice Address - Country:US
Practice Address - Phone:718-239-8359
Practice Address - Fax:718-579-3901
Is Sole Proprietor?:No
Enumeration Date:2009-02-26
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD14676207RH0003X
MA273548207RH0003X
NY303576207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIMD14676OtherRI STATE LICENSE