Provider Demographics
NPI:1205943305
Name:WALSH, JAMES EDWARD (DPM)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:EDWARD
Last Name:WALSH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1078 RT 47 SOUTH
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:NJ
Mailing Address - Zip Code:08242-1608
Mailing Address - Country:US
Mailing Address - Phone:609-886-3737
Mailing Address - Fax:609-886-1854
Practice Address - Street 1:1078 RT 47 SOUTH
Practice Address - Street 2:
Practice Address - City:RIO GRANDE
Practice Address - State:NJ
Practice Address - Zip Code:08242-1608
Practice Address - Country:US
Practice Address - Phone:609-886-3737
Practice Address - Fax:609-886-1854
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD00001234213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ225405Medicaid
NJ225405Medicaid
T99586Medicare UPIN