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General NPI Number Information
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NPI Number | 1316409857
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Entity Type | Individual
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Provider Name | WALTER HILL ELLIOTT IV
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Gender | Male
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Dates
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Enumeration Date | 04/03/2019
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Last Update Date | 03/03/2025
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Provider Practice Location Address
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Address Line | 19 DAVIS AVE
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City | NEPTUNE
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State | NJ
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Zip | 07753-4488
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Country | US
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Telephone | 732-897-3530
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Fax |
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Provider Business Mailing Address
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Address Line | 20 CAROL LN
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City | HOWELL
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State | NJ
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Zip | 07731-1306
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Country | US
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Telephone | 843-607-6992
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 26NJ00903700
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License Number State | NJ
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