Provider Demographics
NPI:1760441414
Name:VALDES, MICHAEL EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:EDWARD
Last Name:VALDES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:E
Other - Last Name:BLANCHE VALDES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8 FAIRVIEW TER
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-2006
Mailing Address - Country:US
Mailing Address - Phone:973-722-2747
Mailing Address - Fax:866-771-3575
Practice Address - Street 1:8 FAIRVIEW TER
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-2006
Practice Address - Country:US
Practice Address - Phone:973-722-2747
Practice Address - Fax:866-771-3575
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA0373262086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
223764418OtherPIN
11397794OtherCAQH
1487248006OtherCIGNA HMO
7203187OtherAETNA
1K7665OtherHEALTHNET
151808Medicare Oscar/Certification