1033306121 NPI number — CHARLES BRUCE WALSH, M.D. LLP

Table of content: (NPI 1033306121)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033306121 NPI number — CHARLES BRUCE WALSH, M.D. LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARLES BRUCE WALSH, M.D. LLP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033306121
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
140 LOCKWOOD AVE
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
NEW ROCHELLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10801-4915
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-636-3373
Provider Business Mailing Address Fax Number:
914-636-8726

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
140 LOCKWOOD AVE
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
NEW ROCHELLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10801-4915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-636-3373
Provider Business Practice Location Address Fax Number:
914-636-8726
Provider Enumeration Date:
10/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CARROLL-MCLANE
Authorized Official First Name:
ELLEN
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
914-636-3373

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  145593-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0722H1 . This is a "BCBS HOSPITAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2473422002 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 280733P . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1447296 . This is a "PHCS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: MAGNACARE . This is a "11303" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0D2758 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 20041170 . This is a "RAIL ROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01019314 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 413191 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4653869 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0722H2 . This is a "BCBS OFFICE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 217377P . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: WS807 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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