Organization
VALLEY CENTER FOR FAMILY MEDICINE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSANNE MUCCINO (OFFICE MGR)
(973) 940-0512
Entity
Organization
Contact information
Practice address
14 VIOLET TRL, LAFAYETTE, NJ 07848-2203
(973) 940-0512
Mailing address
14 VIOLET TRL, LAFAYETTE, NJ 07848-2203
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MA035277
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1163604
—
NJ
Enumeration date
01/22/2007
Last updated
11/29/2011
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