Healthcare Provider Details

I. General information

NPI: 1205943305
Provider Name (Legal Business Name): JAMES EDWARD WALSH DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1078 RT 47 SOUTH
RIO GRANDE NJ
08242-1608
US

IV. Provider business mailing address

1078 RT 47 SOUTH
RIO GRANDE NJ
08242-1608
US

V. Phone/Fax

Practice location:
  • Phone: 609-886-3737
  • Fax: 609-886-1854
Mailing address:
  • Phone: 609-886-3737
  • Fax: 609-886-1854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberMD00001234
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: