Provider Demographics
NPI:1912236365
Name:VALDES TRUJILLO, JORGE
Entity Type:Individual
Prefix:MR
First Name:JORGE
Middle Name:
Last Name:VALDES TRUJILLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 HEMLOCK ST
Mailing Address - Street 2:2 FLOOR
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-3019
Mailing Address - Country:US
Mailing Address - Phone:516-304-2595
Mailing Address - Fax:
Practice Address - Street 1:33 WALT WHITMAN RD
Practice Address - Street 2:300 B
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-3640
Practice Address - Country:US
Practice Address - Phone:631-385-7780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019708-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist