Healthcare Provider Details

I. General information

NPI: 1851362024
Provider Name (Legal Business Name): NICK E VALENZE PT
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 FEURA BUSH RD & 9W
GLENMONT NY
12077-2983
US

IV. Provider business mailing address

365 FEURA BUSH RD & 9W
GLENMONT NY
12077-2983
US

V. Phone/Fax

Practice location:
  • Phone: 518-436-3954
  • Fax: 518-436-4257
Mailing address:
  • Phone: 518-436-3954
  • Fax: 518-436-4257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0100441
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: