1851362024 NPI number — MR. NICK E VALENZE PT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851362024 NPI number — MR. NICK E VALENZE PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VALENZE
Provider First Name:
NICK
Provider Middle Name:
E
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PT
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:
1851362024
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
365 FEURA BUSH RD & 9W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLENMONT
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12077-2983
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-436-3954
Provider Business Mailing Address Fax Number:
518-436-4257

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
365 FEURA BUSH RD & 9W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENMONT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12077-2983
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-436-3954
Provider Business Practice Location Address Fax Number:
518-436-4257
Provider Enumeration Date:
01/27/2006

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: 225100000X , with the licence number:  0100441 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 10002083 . This is a "CAPITAL DISTRICT PHYSICIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6602081 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: Q7304B/CATQ730 . This is a "EMPIRE BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: P1112510 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 131891 . This is a "WELLCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 43524 . This is a "MVP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5554529 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".




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