Provider Demographics
NPI:1386028462
Name:WALSH, JENNIFER
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 SEAVIEW AVENUE NORTH
Mailing Address - Street 2:CLONTARF
Mailing Address - City:DUBLIN
Mailing Address - State:DUBLIN
Mailing Address - Zip Code:3
Mailing Address - Country:IE
Mailing Address - Phone:35387-280-1725
Mailing Address - Fax:
Practice Address - Street 1:622 W 168TH ST PH 1666
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3720
Practice Address - Country:US
Practice Address - Phone:212-305-4098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY280516282NW0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NW0100XHospitalsGeneral Acute Care HospitalWomen