Provider Demographics
NPI:1376913731
Name:WALTER, ERIK (PA-C)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:
Last Name:WALTER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 UNION BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-3104
Mailing Address - Country:US
Mailing Address - Phone:631-238-3067
Mailing Address - Fax:631-458-1041
Practice Address - Street 1:434 UNION BLVD
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795
Practice Address - Country:US
Practice Address - Phone:631-238-3067
Practice Address - Fax:631-458-1041
Is Sole Proprietor?:No
Enumeration Date:2015-09-29
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP99582363A00000X
NY23 019235363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant