Organization
VALLEY STREAM MEDICAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MORONKEJI FAGBEMI (DIRECTOR OFFICER)
(516) 285-5683
Entity
Organization
Contact information
Practice address
3 ALBERT CT, VALLEY STREAM, NY 11580-4944
(516) 285-5683
Mailing address
3 ALBERT CT, VALLEY STREAM, NY 11580-4944
(516) 285-5683
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
Primary
207287
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02073027
—
NY
Enumeration date
12/05/2006
Last updated
08/22/2020
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