Provider Demographics
NPI:1093533127
Name:VALERY, JEAN GERARD JR
Entity type:Individual
Prefix:MR
First Name:JEAN
Middle Name:GERARD
Last Name:VALERY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 VAN SICLEN AVE UNIT 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-6005
Mailing Address - Country:US
Mailing Address - Phone:347-941-8330
Mailing Address - Fax:
Practice Address - Street 1:604 VAN SICLEN AVE UNIT 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-6005
Practice Address - Country:US
Practice Address - Phone:347-941-8330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialist