Provider Demographics
NPI:1336131721
Name:VALENTE, JOHN S (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:S
Last Name:VALENTE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 MIDDLE COUNTRY RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2819
Mailing Address - Country:US
Mailing Address - Phone:631-265-7777
Mailing Address - Fax:631-265-7778
Practice Address - Street 1:319 MIDDLE COUNTRY RD
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2819
Practice Address - Country:US
Practice Address - Phone:631-265-7777
Practice Address - Fax:631-265-7778
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2113213E00000X
FL590213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01691230Medicaid
P17061Medicare PIN
T50657Medicare UPIN
NY0205440001Medicare NSC