Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0120X | Pediatric Surgery | 222161 | NY |
Y | 2086S0120X | Pediatric Surgery | 28576 | NJ |
NPI | 1205931458 |
---|---|
Provider Name | Dr. Victor Valda |
First Address | Hackensack, NJ 07601-8503 |
Second Address | Hackensack, NJ 07601-8503 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2006 |
Last Update Date | 26/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C63029 | (02) | NY |