Provider Demographics
NPI:1780972752
Name:MARGAS-WALSH, JESSICA D (RN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:D
Last Name:MARGAS-WALSH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 EATON LN
Mailing Address - Street 2:
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-2356
Mailing Address - Country:US
Mailing Address - Phone:631-338-8792
Mailing Address - Fax:
Practice Address - Street 1:7 EATON LN
Practice Address - Street 2:
Practice Address - City:CENTEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720-2356
Practice Address - Country:US
Practice Address - Phone:631-338-8792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY580423-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY580423-1Medicaid