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1417090465 NPI number — DIAMOND ERI-C WALKER

NPI Number: 1417090465
Health Care Provider/Practitioner: DIAMOND ERI-C WALKER

Information about “1417090465” NPI (DIAMOND ERI-C WALKER) exists in 1417090465 in HTML format HTML  |  1417090465 in plain Text format TXT  |  1417090465 in PDF (Portable Document Format) PDF  |  1417090465 in an XML format XML  formats.

NPI Number : 1417090465 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1417090465",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WALKER",
    "FirstName": "DIAMOND",
    "MiddleName": "ERI-C",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "91 PROSPECT ST",
    "SecondLineMailingAddress": "SUITE 22",
    "MailingAddressCityName": "EAST ORANGE",
    "MailingAddressStateName": "NJ",
    "MailingAddressPostalCode": "07017-2438",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "80 W MAIN ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MENDHAM",
    "PracticeLocationAddressStateName": "NJ",
    "PracticeLocationAddressPostalCode": "07945-1230",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "973-543-5656",
    "PracticeLocationAddressFaxNumber": "973-543-6772",
    "EnumerationDate": "02/15/2007",
    "LastUpdateDate": "07/08/2007",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "101YA0400X",
        "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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