Provider Demographics
NPI:1619932860
Name:JACQUES, WALTER J (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:J
Last Name:JACQUES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3 HAMILTON HEALTH PL
Mailing Address - Street 2:SUITE A
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-3542
Mailing Address - Country:US
Mailing Address - Phone:609-581-4480
Mailing Address - Fax:609-581-5222
Practice Address - Street 1:3 HAMILTON HEALTH PL
Practice Address - Street 2:SUITE A
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08690-3542
Practice Address - Country:US
Practice Address - Phone:609-581-4480
Practice Address - Fax:609-581-5222
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA55763002080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5393400Medicaid
NJ5393400Medicaid