Provider Demographics
NPI:1417147695
Name:WALSH, DORIT LUBECK (NP)
Entity Type:Individual
Prefix:
First Name:DORIT
Middle Name:LUBECK
Last Name:WALSH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 NORTH HIGHLAND AVE APT 3302
Mailing Address - Street 2:
Mailing Address - City:OSSINING
Mailing Address - State:NY
Mailing Address - Zip Code:10562
Mailing Address - Country:US
Mailing Address - Phone:914-469-5519
Mailing Address - Fax:
Practice Address - Street 1:755 NORTH BROADWAY SUITE 560
Practice Address - Street 2:
Practice Address - City:SLEEPY HOLLOW
Practice Address - State:NY
Practice Address - Zip Code:10591
Practice Address - Country:US
Practice Address - Phone:914-366-5400
Practice Address - Fax:914-366-5401
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2018-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF304052363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02919217Medicaid