Provider Demographics
NPI:1790925329
Name:VALESKY, WALTER WALLACE JR (MD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:WALLACE
Last Name:VALESKY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:WALTER
Other - Middle Name:WALLACE
Other - Last Name:VALESKY
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:767 UNION ST
Mailing Address - Street 2:APT 7A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-1367
Mailing Address - Country:US
Mailing Address - Phone:404-625-0461
Mailing Address - Fax:
Practice Address - Street 1:451 CLARKSON AVE
Practice Address - Street 2:KINGS COUNTY HOSPITAL, DEPT OF EMERGENCY MEDICINE
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203
Practice Address - Country:US
Practice Address - Phone:718-245-4601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-23
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY264753207P00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program