1548806896 NPI number — MR. DANIEL PATRICK WALSH BSC, MSC

Table of content: MR. DANIEL PATRICK WALSH BSC, MSC (NPI 1548806896)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548806896 NPI number — MR. DANIEL PATRICK WALSH BSC, MSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALSH
Provider First Name:
DANIEL
Provider Middle Name:
PATRICK
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
BSC, MSC
Provider Gender Code:
M

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:
1548806896
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/12/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
576 BROADHOLLOW RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MELVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11747-5002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-359-5859
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
390 ROUTE NJ 10
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
RANDOLPH
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07869
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-895-9925
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/21/2019

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: 2251X0800X , with the licence number:  40QA00989900 , 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)





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