Healthcare Provider Details

I. General information

NPI: 1134174972
Provider Name (Legal Business Name): THOMAS E. COUCH, DPM, D. JOEL VALENTINI, DPM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 S LAKE AVE
ALBANY NY
12203-1103
US

IV. Provider business mailing address

89 S LAKE AVE
ALBANY NY
12203-1103
US

V. Phone/Fax

Practice location:
  • Phone: 518-462-5371
  • Fax: 518-462-2379
Mailing address:
  • Phone: 518-462-5371
  • Fax: 518-462-2379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0027761
License Number StateNY

VIII. Authorized Official

Name: DR. D JOEL VALENTINI
Title or Position: MD/PARTNER
Credential: M.D.
Phone: 518-462-5371