Provider Demographics
NPI:1306817507
Name:MAJAK, WALTER HUDSON (DPM)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:HUDSON
Last Name:MAJAK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-4001
Mailing Address - Country:US
Mailing Address - Phone:315-782-4800
Mailing Address - Fax:315-788-6835
Practice Address - Street 1:513 WASHINGTON ST
Practice Address - Street 2:SUITE 2
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-4001
Practice Address - Country:US
Practice Address - Phone:315-782-4800
Practice Address - Fax:315-788-6835
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0034861213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T83172Medicare UPIN
NYDD5383Medicare PIN