MEDICARE: JASPER WALKER SR.

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	302R00000X	Health Maintenance Organization	LA1122593	NY

General Provider Information

NPI Number	:	1760209415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASPER WALKER SR.

Provider Business Mailing Address
First Line	:	335 PACIFIC AVE
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07304-3711
Country	:	US
Telephone Number	:	201-699-7382
Fax Number	:

Provider Business Practice Location Address
First Line	:	374 COMMUNIPAW AVE
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07304-3724
Country	:	US
Telephone Number	:	201-433-1888
Fax Number	:

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

Provider Enumeration Date	:	09/24/2024
Last Update Date	:	09/24/2024

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Directions to “ JASPER WALKER SR. ” Practice Location

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