1801224845 NPI number — AMY WALKA MA, MS

Table of content: AMY WALKA MA, MS (NPI 1801224845)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801224845 NPI number — AMY WALKA MA, MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALKA
Provider First Name:
AMY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, MS
Provider Gender Code:
F

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:
1801224845
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27 WARREN ST
Provider Second Line Business Mailing Address:
PO BOX 3000
Provider Business Mailing Address City Name:
SOMERVILLE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08876-2921
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-231-6475
Provider Business Mailing Address Fax Number:
908-526-0536

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 REHILL AVE
Provider Second Line Business Practice Location Address:
SOMERSET MEDICAL CENTER EMERGENCY ROOM
Provider Business Practice Location Address City Name:
SOMERVILLE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08876-2519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-526-4100
Provider Business Practice Location Address Fax Number:
908-526-0536
Provider Enumeration Date:
10/30/2013

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: 101YM0800X , with the licence number:  S-4588 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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