Provider Demographics
NPI:1093836041
Name:POPRYCZ, WALTER (MD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:
Last Name:POPRYCZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 WHITE HORSE PIKE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HADDON HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035-1299
Mailing Address - Country:US
Mailing Address - Phone:856-547-2323
Mailing Address - Fax:856-547-7932
Practice Address - Street 1:17 WHITE HORSE PIKE
Practice Address - Street 2:SUITE 1
Practice Address - City:HADDON HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08035-1299
Practice Address - Country:US
Practice Address - Phone:856-547-2323
Practice Address - Fax:856-547-7932
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA43810207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2270501Medicaid
NJ2270501Medicaid
067409AP6Medicare PIN