Healthcare Provider Details

I. General information

NPI: 1316135494
Provider Name (Legal Business Name): CHRISTOPHER J. WALSH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2007
Last Update Date: 10/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E GUN HILL RD
BRONX NY
10467-6110
US

IV. Provider business mailing address

24 PIERMONT RD
ROCKLEIGH NJ
07647-2712
US

V. Phone/Fax

Practice location:
  • Phone: 646-851-9324
  • Fax:
Mailing address:
  • Phone: 646-851-9324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number236202
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: