Provider Demographics
NPI:1154474419
Name:WALSON MEDICAL SUPPORT ELEMENT
Entity Type:Organization
Organization Name:WALSON MEDICAL SUPPORT ELEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DCCS
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-562-5419
Mailing Address - Street 1:1562 MARINE PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-3414
Mailing Address - Country:US
Mailing Address - Phone:347-733-9938
Mailing Address - Fax:
Practice Address - Street 1:5631 BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:FT. DIX
Practice Address - State:NJ
Practice Address - Zip Code:08640-0000
Practice Address - Country:US
Practice Address - Phone:609-562-5419
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMF333963-1261QM1102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1102XAmbulatory Health Care FacilitiesClinic/CenterMilitary Outpatient Operational (Transportable) Component