Provider Demographics
NPI:1871862573
Name:RAMON VALLARINO JR MD PC
Entity Type:Organization
Organization Name:RAMON VALLARINO JR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:VALLARINO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:516-524-1605
Mailing Address - Street 1:3704 91ST ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-7914
Mailing Address - Country:US
Mailing Address - Phone:718-396-1742
Mailing Address - Fax:718-396-3297
Practice Address - Street 1:3704 91ST ST
Practice Address - Street 2:SUITE C
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7914
Practice Address - Country:US
Practice Address - Phone:718-396-1742
Practice Address - Fax:718-396-3297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-26
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205319261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01756041Medicaid
A400024158Medicare PIN
NY01756041Medicaid
NYG400060569Medicare PIN