Provider Demographics
NPI:1760472377
Name:WALSH, KRISTIN
Entity Type:Individual
Prefix:
First Name:KRISTIN
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 1:258 HIGH AVE
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-2407
Mailing Address - Country:US
Mailing Address - Phone:845-353-1441
Mailing Address - Fax:845-353-1987
Practice Address - Street 1:258 HIGH AVE
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-2407
Practice Address - Country:US
Practice Address - Phone:845-353-1441
Practice Address - Fax:845-353-1987
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF000808174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2815605OtherAETNA HMO #
NYMFM281OtherEMPIRE BCBS #
NY000000087075OtherGHI HMO #
NY1899665OtherGHI PPO #
NY100808OtherCONNECTICARE #
NYP3133224OtherOXFORD #
NY0D3130OtherHEALTHNET #
NY207614OtherWELLCARE #
NY01954690Medicaid
NY1000003401OtherAFFINITY HEALTH PLANS #
NY366082OtherMVP #
NY7941264OtherAETNA PPO #
NYF006808OtherHIP #
NYWK0808OtherATLANTIS HEALTH PLAN #
NYP3133224OtherOXFORD #
NYWK0808OtherATLANTIS HEALTH PLAN #