Provider Demographics
NPI:1235832627
Name:WALTERS, JUSTIN URIAH (MD)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:URIAH
Last Name:WALTERS
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 1:15 GOLDSMITH DR
Mailing Address - Street 2:
Mailing Address - City:SPOTSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08884-1032
Mailing Address - Country:US
Mailing Address - Phone:516-974-4678
Mailing Address - Fax:
Practice Address - Street 1:1135 BROAD ST STE 201
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3346
Practice Address - Country:US
Practice Address - Phone:973-754-4125
Practice Address - Fax:973-754-4190
Is Sole Proprietor?:No
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ10535854207Q00000X
NJ1992911937207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine