Provider Demographics
NPI:1679560908
Name:DEL VALLE, JACQUELINE P (MD)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:P
Last Name:DEL VALLE
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:PO BOX 315
Mailing Address - Street 2:
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730-0315
Mailing Address - Country:US
Mailing Address - Phone:732-607-9000
Mailing Address - Fax:732-383-6026
Practice Address - Street 1:3 HOSPITAL PLZ STE 309
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-3095
Practice Address - Country:US
Practice Address - Phone:732-607-9000
Practice Address - Fax:732-383-6026
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06154000208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G10839Medicare UPIN
789602NV4Medicare ID - Type Unspecified