Basic Information
Provider Information
NPI: 1871572388
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: VALEMBRUN
FirstName: LAVONNE
MiddleName: JUNITA
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: WILLIAMS
OtherFirstName: LAVONNE
OtherMiddleName: JUNITA
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: M.D.
OtherLastNameType: 1
Mailing Information
Address1: 1724 E 54TH ST
Address2:  
City: BROOKLYN
State: NY
PostalCode: 112343922
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 451 CLARKSON AVE
Address2:  
City: BROOKLYN
State: NY
PostalCode: 112032057
CountryCode: US
TelephoneNumber: 7182453422
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/12/2006
LastUpdateDate: 02/12/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X232183NYY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


Home