Provider Demographics
NPI:1881602852
Name:VALLEY BEHAVIORAL MEDICINE, PC
Entity type:Organization
Organization Name:VALLEY BEHAVIORAL MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:V
Authorized Official - Last Name:ABBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-291-7480
Mailing Address - Street 1:3 HATFIELD LANE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-6732
Mailing Address - Country:US
Mailing Address - Phone:845-291-7480
Mailing Address - Fax:845-294-3785
Practice Address - Street 1:3 HATFIELD LANE
Practice Address - Street 2:SUITE 1
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-6732
Practice Address - Country:US
Practice Address - Phone:845-291-7480
Practice Address - Fax:845-294-3785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW86391Medicare PIN