Provider Demographics
NPI:1154306330
Name:ROJAS, WALTER R (MD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:R
Last Name:ROJAS
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 1:531 MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006
Mailing Address - Country:US
Mailing Address - Phone:718-909-5830
Mailing Address - Fax:718-892-5505
Practice Address - Street 1:1381 WHITE PLAINS ROAD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462
Practice Address - Country:US
Practice Address - Phone:718-909-5830
Practice Address - Fax:718-892-5505
Is Sole Proprietor?:No
Enumeration Date:2005-12-12
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235046207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02639325Medicaid
NY02639325Medicaid
2192P1Medicare ID - Type Unspecified