Provider Demographics
NPI:1457589814
Name:VALLEY WEST MEDICAL
Entity Type:Organization
Organization Name:VALLEY WEST MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:T
Authorized Official - Last Name:PECORELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-438-5500
Mailing Address - Street 1:245 VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:WOOD RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07075-1236
Mailing Address - Country:US
Mailing Address - Phone:201-438-5500
Mailing Address - Fax:201-438-3363
Practice Address - Street 1:245 VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:WOOD RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07075-1236
Practice Address - Country:US
Practice Address - Phone:201-438-5500
Practice Address - Fax:201-438-3363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-24
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty