MEDICARE: DR. AMEETA AHUJA WALIA D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	232789	NY

General Provider Information

NPI Number	:	1689817439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMEETA AHUJA WALIA D.O.

Provider Business Mailing Address
First Line	:	2001 MARCUS AVE
Second Line	:	SUITE N 210
City	:	LAKE SUCCESS
State	:	NY
Zip	:	11042-2061
Country	:	US
Telephone Number	:	516-354-3278
Fax Number	:	516-354-2700

Provider Business Practice Location Address
First Line	:	2001 MARCUS AVE
Second Line	:	SUITE N 210
City	:	LAKE SUCCESS
State	:	NY
Zip	:	11042-2061
Country	:	US
Telephone Number	:	516-354-3278
Fax Number	:	516-354-2700

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2009
Last Update Date	:	09/26/2013

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