Healthcare Provider Details

I. General information

NPI: 1912207648
Provider Name (Legal Business Name): ELAINE MARY WALSH ANP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2010
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 EARLE OVINGTON BLVD
UNIONDALE NY
11553-3610
US

IV. Provider business mailing address

535 E 70TH ST
NEW YORK NY
10021-4898
US

V. Phone/Fax

Practice location:
  • Phone: 516-941-2039
  • Fax: 516-222-6893
Mailing address:
  • Phone: 516-941-2039
  • Fax: 516-222-6893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number305344
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: