Provider Demographics
NPI:1316490675
Name:VALENZUELA, NELSON
Entity type:Individual
Prefix:
First Name:NELSON
Middle Name:
Last Name:VALENZUELA
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 1:60 MADISON AVE
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-1600
Mailing Address - Country:US
Mailing Address - Phone:212-545-2400
Mailing Address - Fax:646-312-0481
Practice Address - Street 1:4215 3RD AVE FL 2
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-4501
Practice Address - Country:US
Practice Address - Phone:718-294-5891
Practice Address - Fax:718-294-2468
Is Sole Proprietor?:No
Enumeration Date:2016-08-03
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF340890-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04532298Medicaid
NYG100000410Medicare Oscar/Certification
WI331943Medicare Oscar/Certification
WI331944Medicare Oscar/Certification
WI331946Medicare Oscar/Certification
WI331954Medicare Oscar/Certification
WI331043Medicare Oscar/Certification
WI331947Medicare Oscar/Certification
WI331978Medicare Oscar/Certification
WI331945Medicare Oscar/Certification
WI331058Medicare Oscar/Certification
WI331009Medicare Oscar/Certification
NY00695941Medicaid
WI331952Medicare Oscar/Certification