Provider Demographics
NPI:1043926744
Name:WALSH, KYLE J
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:J
Last Name:WALSH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 HARRISON ST FL 2
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-3552
Mailing Address - Country:US
Mailing Address - Phone:973-986-0321
Mailing Address - Fax:
Practice Address - Street 1:95 HARRISON ST FL 2
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-3552
Practice Address - Country:US
Practice Address - Phone:973-986-0321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer