Healthcare Provider Details

I. General information

NPI: 1457073454
Provider Name (Legal Business Name): JOHN WALCH JR. NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2022
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 W JIMMIE LEEDS RD STE 4
GALLOWAY NJ
08205-9438
US

IV. Provider business mailing address

1418 NEW RD STE 2
NORTHFIELD NJ
08225-1179
US

V. Phone/Fax

Practice location:
  • Phone: 609-404-0056
  • Fax:
Mailing address:
  • Phone: 609-796-2119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ01354400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: