Provider Demographics
NPI:1487487039
Name:VALLEY DOLOR LLC
Entity type:Organization
Organization Name:VALLEY DOLOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTIONER
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NICKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:845-391-0338
Mailing Address - Street 1:1 CORWIN CT
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-5190
Mailing Address - Country:US
Mailing Address - Phone:845-391-2984
Mailing Address - Fax:
Practice Address - Street 1:1 CORWIN CT
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-5190
Practice Address - Country:US
Practice Address - Phone:845-391-0338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain