Provider Demographics
NPI:1942374152
Name:VALANTE, WILLIAM
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:VALANTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:669 WESTWOOD AVENUE
Mailing Address - Street 2:PARK RIDGE WIG CENTER
Mailing Address - City:RIVER VALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07675
Mailing Address - Country:US
Mailing Address - Phone:201-594-1123
Mailing Address - Fax:201-594-0388
Practice Address - Street 1:PARK RIDGE WIG CENTER 669 WESTWOOD AVENUE
Practice Address - Street 2:
Practice Address - City:RIVER VALE
Practice Address - State:NJ
Practice Address - Zip Code:07675
Practice Address - Country:US
Practice Address - Phone:201-594-1123
Practice Address - Fax:201-594-0388
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG75521OtherEMPIRE BLUE CROSS
NYG75521OtherEMPIRE BLUE CROSS