Healthcare Provider Details

I. General information

NPI: 1124522081
Provider Name (Legal Business Name): KYLE ROBERT WALDING DO, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 9TH AVE FL 3
NEW YORK NY
10001-5701
US

IV. Provider business mailing address

303 9TH AVE FL 3
NEW YORK NY
10001-5701
US

V. Phone/Fax

Practice location:
  • Phone: 212-771-0198
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number327994
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: