Provider Demographics
NPI:1063453066
Name:VALENTI, STEPHEN (PA)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:VALENTI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 EVERETT ROAD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12608
Mailing Address - Country:US
Mailing Address - Phone:518-453-9088
Mailing Address - Fax:518-587-5068
Practice Address - Street 1:121 EVERETT ROAD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12608
Practice Address - Country:US
Practice Address - Phone:518-453-9088
Practice Address - Fax:518-587-5068
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0071271363AS0400X
NY363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1247694Medicaid
NYCC1483Medicare ID - Type Unspecified
P11783Medicare UPIN