Healthcare Provider Details

I. General information

NPI: 1245318682
Provider Name (Legal Business Name): J WALKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 04/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 MANETTO HILL RD
PLAINVIEW NY
11803-1324
US

IV. Provider business mailing address

146 MANETTO HILL RD
PLAINVIEW NY
11803-1324
US

V. Phone/Fax

Practice location:
  • Phone: 516-822-3600
  • Fax: 516-822-0008
Mailing address:
  • Phone: 516-822-3600
  • Fax: 516-822-0008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number143375-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier01070488
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: