Provider Demographics
NPI:1023106424
Name:BIENVENIDO C & TERESITY VALENCIA MD PA
Entity type:Organization
Organization Name:BIENVENIDO C & TERESITY VALENCIA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BIENVENIDO
Authorized Official - Middle Name:C
Authorized Official - Last Name:VALENCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-881-0279
Mailing Address - Street 1:363 21ST AVE
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07501-3640
Mailing Address - Country:US
Mailing Address - Phone:973-881-0279
Mailing Address - Fax:
Practice Address - Street 1:363 21ST AVE
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07501-3640
Practice Address - Country:US
Practice Address - Phone:973-881-0279
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA027214174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1090704Medicaid
NJ0477401Medicaid
NJ0477401Medicaid