Basic Information
| Provider Information | |||||||||
| NPI: | 1962430991 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WALSH | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19 BRADHURST AVENUE | ||||||||
| Address2: | SUITE 1300 N | ||||||||
| City: | HAWTHORNE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147892700 | ||||||||
| FaxNumber: | 9147892744 | ||||||||
| Practice Location | |||||||||
| Address1: | 19 BRADHURST AVENUE | ||||||||
| Address2: | SUITE 1300 N | ||||||||
| City: | HAWTHORNE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147892700 | ||||||||
| FaxNumber: | 9147892744 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 05/21/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 097304 | NY | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 00324621 | 05 | NY | MEDICAID |