Provider Demographics
NPI:1700532587
Name:PSYCHIATRY ON VIDEO LLC
Entity Type:Organization
Organization Name:PSYCHIATRY ON VIDEO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:YISSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:DELVALLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-490-4075
Mailing Address - Street 1:6000 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-1420
Mailing Address - Country:US
Mailing Address - Phone:201-490-4075
Mailing Address - Fax:201-917-7871
Practice Address - Street 1:162 E RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3859
Practice Address - Country:US
Practice Address - Phone:201-470-4006
Practice Address - Fax:201-917-7871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-01
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty