1215088067 NPI number — DR. DOMINIC JOHN VALENTINO III D.O.

Table of content: DR. DOMINIC JOHN VALENTINO III D.O. (NPI 1215088067)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215088067 NPI number — DR. DOMINIC JOHN VALENTINO III D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VALENTINO
Provider First Name:
DOMINIC
Provider Middle Name:
JOHN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215088067
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1500 LANSDOWNE AVE
Provider Second Line Business Mailing Address:
MS-044
Provider Business Mailing Address City Name:
DARBY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19023-1200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-237-7337
Provider Business Mailing Address Fax Number:
610-237-5093

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
239 HURFFVILLE CROSSKEYS RD
Provider Second Line Business Practice Location Address:
STE 450
Provider Business Practice Location Address City Name:
SEWELL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08080
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-341-8390
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/16/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  OS012291 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: OS012291 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RS0012X , with the licence number: OS012291 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0200X , with the licence number: OS012291 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)