Provider Demographics
NPI:1205931458
Name:VALDA, VICTOR (MD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:
Last Name:VALDA
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 1:5 SUMMIT AVE
Mailing Address - Street 2:SUITE # 6
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-8503
Mailing Address - Country:US
Mailing Address - Phone:201-343-6885
Mailing Address - Fax:
Practice Address - Street 1:5 SUMMIT AVE
Practice Address - Street 2:SUITE # 6
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-8503
Practice Address - Country:US
Practice Address - Phone:201-343-6885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2221612086S0120X
NJ285762086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY462H71Medicare ID - Type Unspecified
NYC63029Medicare UPIN