Provider Demographics
NPI:1356806020
Name:WALKER, JOHN ANTHONY
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ANTHONY
Last Name:WALKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JUAN
Other - Middle Name:FRANCISCO
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:408 GREENWICH ST
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-6320
Mailing Address - Country:US
Mailing Address - Phone:516-967-8979
Mailing Address - Fax:
Practice Address - Street 1:408 GREENWICH ST
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-6320
Practice Address - Country:US
Practice Address - Phone:516-967-8979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-06
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator