Provider Demographics
NPI:1629193503
Name:VALLEY OBSTETRICS AND GYNECOLOGY, PC
Entity Type:Organization
Organization Name:VALLEY OBSTETRICS AND GYNECOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AZZAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:SALEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-483-5893
Mailing Address - Street 1:1 WEBSTER AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-1362
Mailing Address - Country:US
Mailing Address - Phone:845-483-5893
Mailing Address - Fax:845-471-4381
Practice Address - Street 1:1 WEBSTER AVE STE 300
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1362
Practice Address - Country:US
Practice Address - Phone:845-483-5893
Practice Address - Fax:845-471-4381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY161168207V00000X
NY159629207V00000X
NY138741207V00000X
NY141726207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01147566Medicaid
NY00646117Medicaid
NY02050860Medicaid
NY00432682Medicaid
NY01147502Medicaid
NY034L60Medicare ID - Type Unspecified
NY00646117Medicaid
NY082A41Medicare ID - Type Unspecified
NY058A52Medicare ID - Type Unspecified
NYB16861Medicare UPIN
NY00432682Medicaid
NY053D20Medicare ID - Type Unspecified
NY01147502Medicaid
NY01147566Medicaid