Individual
STACYAN P VALENTINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
165 PASSAIC AVE, FAIRFIELD, NJ 07004-3521
(862) 276-5137
Mailing address
165 PASSAIC AVE, FAIRFIELD, NJ 07004-3521
(862) 276-5137
Taxonomy
Speciality
Code
Description
License number
State
342000000X
Transportation Network Company
Primary
0451091871
NJ
Other
Enumeration date
05/01/2024
Last updated
05/01/2024
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