Provider Demographics
NPI:1215987862
Name:VALOW-PICARELLO, LISA MARIE (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:VALOW-PICARELLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 DILTZ RD
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-2720
Mailing Address - Country:US
Mailing Address - Phone:845-362-4092
Mailing Address - Fax:
Practice Address - Street 1:505 ROUTE 208
Practice Address - Street 2:SUITE 15
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-1608
Practice Address - Country:US
Practice Address - Phone:845-783-6699
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204365207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine