1285854588 NPI number — PHILIP A WALKER

Table of content: (NPI 1285854588)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285854588 NPI number — PHILIP A WALKER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHILIP A WALKER
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:
6
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:
1285854588
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 153
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENWICH
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06836-0153
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-588-9323
Provider Business Mailing Address Fax Number:
203-588-9325

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1069 E MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 308
Provider Business Practice Location Address City Name:
STAMFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06902-4311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-588-9323
Provider Business Practice Location Address Fax Number:
203-588-9325
Provider Enumeration Date:
04/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WALKER
Authorized Official First Name:
PHILIP
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
203-588-9323

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 004271491 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com