Provider Demographics
NPI:1881732840
Name:DELVALLE, JUDITH (MD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:
Last Name:DELVALLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4033 76TH ST APT 3C
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-1036
Mailing Address - Country:US
Mailing Address - Phone:718-335-0033
Mailing Address - Fax:
Practice Address - Street 1:4033 76TH ST APT 3C
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1036
Practice Address - Country:US
Practice Address - Phone:718-335-0033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193639207R00000X
NY193639-1207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine