Provider Demographics
NPI:1760440770
Name:VALLE, CARLOS F (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:F
Last Name:VALLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 WALL ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-3849
Mailing Address - Country:US
Mailing Address - Phone:845-339-3736
Mailing Address - Fax:845-339-3736
Practice Address - Street 1:291 WALL ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-3849
Practice Address - Country:US
Practice Address - Phone:845-339-3736
Practice Address - Fax:845-339-3736
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1982852084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03686660Medicaid
NY08M571Medicare PIN
NY03686660Medicaid