Provider Demographics
NPI:1285854588
Name:PHILIP A WALKER
Entity Type:Organization
Organization Name:PHILIP A WALKER
Other - Org Name:NORTHEAST DURABLE MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:A
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:203-588-9323
Mailing Address - Street 1:P.O. BOX 153
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06836-0153
Mailing Address - Country:US
Mailing Address - Phone:203-588-9323
Mailing Address - Fax:203-588-9325
Practice Address - Street 1:1069 E MAIN ST
Practice Address - Street 2:SUITE 308
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-4311
Practice Address - Country:US
Practice Address - Phone:203-588-9323
Practice Address - Fax:203-588-9325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004271491Medicaid
CT6001910001Medicare NSC