1477707198 NPI number — MRS. AMY J WALTER P.T., D.P.T.

Table of content: MRS. AMY J WALTER P.T., D.P.T. (NPI 1477707198)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477707198 NPI number — MRS. AMY J WALTER P.T., D.P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALTER
Provider First Name:
AMY
Provider Middle Name:
J
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.T., D.P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JACOBS
Provider Other First Name:
AMY
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.T., D.P.T.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1477707198
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3085 HARLEM ROAD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
CHEEKTOWAGA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14225-2591
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-844-5000
Provider Business Mailing Address Fax Number:
716-844-5050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3085 HARLEM ROAD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
CHEEKTOWAGA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14225-2591
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-844-5000
Provider Business Practice Location Address Fax Number:
716-844-5050
Provider Enumeration Date:
11/07/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  030475-NG , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 030475-1 , 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: 1477707198 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 9315468 . This is a "INDEPENDENT HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 11303 . This is a "AETNA/MAGNCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000531015001 . This is a "BLUE CROSS WNY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1053747 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1477707198 . This is a "NOVA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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