Provider Demographics
NPI:1679946289
Name:WALTON, AUSTIN SR
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:WALTON
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:581 MAIN ST STE 640
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07095-1196
Mailing Address - Country:US
Mailing Address - Phone:732-204-1636
Mailing Address - Fax:
Practice Address - Street 1:581 MAIN ST STE 640
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095-1196
Practice Address - Country:US
Practice Address - Phone:732-204-1636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare