Provider Demographics
NPI:1942632088
Name:WALTER, BRIZA V (MD)
Entity Type:Individual
Prefix:
First Name:BRIZA
Middle Name:V
Last Name:WALTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 WINDSOR DR
Mailing Address - Street 2:
Mailing Address - City:PINE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07058-9757
Mailing Address - Country:US
Mailing Address - Phone:973-908-3368
Mailing Address - Fax:201-353-3692
Practice Address - Street 1:65 WINDSOR DR
Practice Address - Street 2:
Practice Address - City:PINE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07058-9757
Practice Address - Country:US
Practice Address - Phone:973-908-3368
Practice Address - Fax:201-353-3692
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-31
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09325400207V00000X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center