1417241951 NPI number — ROBERT S.WALSKY MD, PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417241951 NPI number — ROBERT S.WALSKY MD, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBERT S.WALSKY MD, PA
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:
1417241951
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
452 OLD HOOK RD
Provider Second Line Business Mailing Address:
SUITE 302
Provider Business Mailing Address City Name:
EMERSON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07630-1381
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-967-1105
Provider Business Mailing Address Fax Number:
201-967-1272

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
452 OLD HOOK RD
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
EMERSON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07630-1381
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-967-1105
Provider Business Practice Location Address Fax Number:
201-967-1272
Provider Enumeration Date:
06/01/2011

Additional Information

Authorized Official

Authorized Official Last Name:
WALSKY
Authorized Official First Name:
NORMA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
201-967-1105

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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