Healthcare Provider Details

I. General information

NPI: 1063410470
Provider Name (Legal Business Name): ERIC G WALTER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2005
Last Update Date: 10/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E 233RD ST SUITE 3
BRONX NY
10466-2604
US

IV. Provider business mailing address

600 E 233RD ST SUITE 3
BRONX NY
10466-2604
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-2060
  • Fax: 718-920-6889
Mailing address:
  • Phone: 718-920-2060
  • Fax: 718-920-6889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN004733
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number004733
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: