Provider Demographics
NPI:1134665631
Name:ROBERT S.WALSKY MD
Entity Type:Organization
Organization Name:ROBERT S.WALSKY MD
Other - Org Name:D/B ROBERT S.WALSKYMD LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:WALSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-967-1105
Mailing Address - Street 1:22 ANGELA CT
Mailing Address - Street 2:
Mailing Address - City:WOODCLIFF LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07677-8102
Mailing Address - Country:US
Mailing Address - Phone:201-967-1105
Mailing Address - Fax:201-391-9805
Practice Address - Street 1:22 ANGELA CT
Practice Address - Street 2:
Practice Address - City:WOODCLIFF LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07677-8102
Practice Address - Country:US
Practice Address - Phone:201-967-1105
Practice Address - Fax:201-391-9805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-09
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA301052086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty