Provider Demographics
NPI:1780682286
Name:VALENTINE, EDWARD SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:SCOTT
Last Name:VALENTINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-2656
Mailing Address - Country:US
Mailing Address - Phone:212-627-0042
Mailing Address - Fax:
Practice Address - Street 1:DEPT RADIATION ONCOLOGY
Practice Address - Street 2:STONY BROOK UNIVERSITY HOSPITAL
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-0001
Practice Address - Country:US
Practice Address - Phone:631-444-2211
Practice Address - Fax:631-444-6034
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1490092085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00858993Medicaid
NY26D49Medicare ID - Type Unspecified
NYB80730Medicare UPIN