Provider Demographics
NPI:1205849403
Name:GEARY, WALTER A (DMD MS)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:A
Last Name:GEARY
Suffix:
Gender:M
Credentials:DMD MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2045 RTE 35 S
Mailing Address - Street 2:
Mailing Address - City:SOUTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08879
Mailing Address - Country:US
Mailing Address - Phone:732-727-5000
Mailing Address - Fax:732-525-8566
Practice Address - Street 1:2045 RTE 35 S
Practice Address - Street 2:
Practice Address - City:SOUTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08879
Practice Address - Country:US
Practice Address - Phone:732-727-5000
Practice Address - Fax:732-525-8566
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D101684101122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5530690001OtherDMEPOS
NV096787OtherGROUP PIN
NJ5530690001OtherDMEPOS
NJ096814UVEMedicare ID - Type UnspecifiedRENDERING