Valley Stream Medical PC

Primary specialty

Legal MedicineTaxonomy code 173000000X

License

207287 Issued in NY

Legal business name

VALLEY STREAM MEDICAL PC

Practice address

3 Albert CT
Valley Stream, NY 11580-4944

Phone

(516) 285-5683

NPI assigned

Dec 5, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Moronkeji FagbemiNPI 1306913371

Title

Director Officer

Phone

(516) 285-5683

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Moronkeji Olapade Fagbemi, M.D

  • Addiction Medicine (Internal Medicine) Physician
  • Valley Stream, NY
  • NPI 1306913371
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1801954680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 ALBERT CT",
            "city": "VALLEY STREAM",
            "state": "NY",
            "postal_code": "115804944",
            "telephone_number": "516-285-5683"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 ALBERT CT",
            "city": "VALLEY STREAM",
            "state": "NY",
            "postal_code": "115804944",
            "telephone_number": "516-285-5683"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VALLEY STREAM MEDICAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FAGBEMI",
        "authorized_official_first_name": "MORONKEJI",
        "authorized_official_title_or_position": "DIRECTOR OFFICER",
        "authorized_official_telephone_number": "516-285-5683"
    },
    "taxonomies": [
        {
            "code": "173000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Legal Medicine",
            "state": "NY",
            "license": "207287",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02073027",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Valley Home Care Inc.
• Valley Medical Care PC
• Valley Stream Central High School District
• Valley Stream Chiropractor PC
• Valley Stream Medical Associates, P.C.
• Valley Stream Medical Services PC
• Valley Stream Optomerty & Optician PLLC (Howard Eyecare)
• Valley Stream Optometric Services PC
• Valley Stream Optometry PLLC (Howard Eyecare)
• Valley Stream Pharmacy Inc (Valley Stream Pharmacy)

• Legal Medicine in Valley Stream, NY
• Providers in Valley Stream, NY by specialty
• Legal Medicine in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.