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NPI Code Detail

MEDICARE: JOHN FELIX WALLER M.D.

MEDICARE: JOHN FELIX WALLER M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist112971NY

General Provider Information

NPI Number : 1851399216
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN FELIX WALLER M.D.
Provider Business Mailing Address
First Line : 333 E 56TH ST
Second Line :
City : NEW YORK
State : NY
Zip : 10022-3758
Country : US
Telephone Number : 212-289-3236
Fax Number : 212-289-1880
Provider Business Practice Location Address
First Line : 333 E 56TH ST
Second Line : OFC 1
City : NEW YORK
State : NY
Zip : 10022-3758
Country : US
Telephone Number : 212-289-3236
Fax Number : 212-289-1880
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2005
Last Update Date : 02/21/2018

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