Provider Demographics
NPI:1821584426
Name:VALLEY URGENT CARE
Entity Type:Organization
Organization Name:VALLEY URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ZEIAD
Authorized Official - Middle Name:ABRAHAM
Authorized Official - Last Name:FAKHOURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-635-1590
Mailing Address - Street 1:1141 STATE ROUTE 55
Mailing Address - Street 2:
Mailing Address - City:LAGRANGEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12540-5005
Mailing Address - Country:US
Mailing Address - Phone:845-223-3333
Mailing Address - Fax:
Practice Address - Street 1:1141 STATE ROUTE 55
Practice Address - Street 2:
Practice Address - City:LAGRANGEVILLE
Practice Address - State:NY
Practice Address - Zip Code:12540-5005
Practice Address - Country:US
Practice Address - Phone:845-223-3333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAKHOURI MEDICAL HEALTH OFFICE P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1598947194Medicaid