Provider Demographics
NPI:1306493606
Name:VALLON, CAMY ALEXANDRE
Entity type:Individual
Prefix:
First Name:CAMY
Middle Name:ALEXANDRE
Last Name:VALLON
Suffix:
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 1:833 CHESS DR
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-4308
Mailing Address - Country:US
Mailing Address - Phone:347-522-7137
Mailing Address - Fax:
Practice Address - Street 1:15715 19TH AVE
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-3820
Practice Address - Country:US
Practice Address - Phone:347-522-7137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty