1265492623 NPI number — DR. DINO JOEL VALENTINI DPM

Table of content: DR. DINO JOEL VALENTINI DPM (NPI 1265492623)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265492623 NPI number — DR. DINO JOEL VALENTINI DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VALENTINI
Provider First Name:
DINO
Provider Middle Name:
JOEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VALENTINI
Provider Other First Name:
D. JOEL
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPM
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1265492623
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 455
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12181-0455
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-272-0881
Provider Business Mailing Address Fax Number:
518-272-0965

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 FEDERAL ST
Provider Second Line Business Practice Location Address:
SUITE 601
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12180-2867
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-272-0881
Provider Business Practice Location Address Fax Number:
518-272-0965
Provider Enumeration Date:
03/27/2006

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: 213E00000X , with the licence number:  002776-1 , 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: BA1074 . This is a "MEDICARE GROUP #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00414613 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5898310001 . This is a "MEDICARE DME" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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