Healthcare Provider Details

I. General information

NPI: 1477973592
Provider Name (Legal Business Name): ELLIOT WALTERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2014
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 BRUNSWICK AVE
TRENTON NJ
08638-4143
US

IV. Provider business mailing address

750 BRUNSWICK AVE
TRENTON NJ
08638-4143
US

V. Phone/Fax

Practice location:
  • Phone: 609-394-6000
  • Fax:
Mailing address:
  • Phone: 609-394-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberMD486109
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number25IA13097500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: