Provider Demographics
NPI:1821237033
Name:WALTER I DELPH MD PC
Entity Type:Organization
Organization Name:WALTER I DELPH MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:I
Authorized Official - Last Name:DELPH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-523-2442
Mailing Address - Street 1:1090 AMSTERDAM AVE
Mailing Address - Street 2:SUITE 7G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-1737
Mailing Address - Country:US
Mailing Address - Phone:212-523-4224
Mailing Address - Fax:
Practice Address - Street 1:1090 AMSTERDAM AVE
Practice Address - Street 2:SUITE 7G
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-1737
Practice Address - Country:US
Practice Address - Phone:212-523-4224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY118180208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00277885Medicaid
NY00277885Medicaid
NY693181Medicare PIN