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General NPI Number Information
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NPI Number | 1033306121
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Entity Type | Organization
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Legal Business Name | CHARLES BRUCE WALSH, M.D. LLP
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Dates
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Enumeration Date | 10/02/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 140 LOCKWOOD AVE SUITE 103
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City | NEW ROCHELLE
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State | NY
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Zip | 10801-4915
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Country | US
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Telephone | 914-636-3373
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Fax | 914-636-8726
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Provider Business Mailing Address
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Address Line | 140 LOCKWOOD AVE SUITE 103
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City | NEW ROCHELLE
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State | NY
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Zip | 10801-4915
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Country | US
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Telephone | 914-636-3373
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Fax | 914-636-8726
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. ELLEN CARROLL-MCLANE
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Credential |
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Telephone | 914-636-3373
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 145593-1
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License Number State | NY
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