Provider Demographics
NPI:1619075652
Name:VALLEY DIAGNOSTIC MEDICAL CENTER
Entity Type:Organization
Organization Name:VALLEY DIAGNOSTIC MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCANIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-327-0500
Mailing Address - Street 1:470 N FRANKLIN TPKE STE 203
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-1385
Mailing Address - Country:US
Mailing Address - Phone:201-327-0500
Mailing Address - Fax:201-327-8612
Practice Address - Street 1:470 N FRANKLIN TPKE STE 203
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-1385
Practice Address - Country:US
Practice Address - Phone:201-327-0500
Practice Address - Fax:201-327-8612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ527375Medicare ID - Type Unspecified