Provider Demographics
NPI:1912207648
Name:WALSH, ELAINE MARY (ANP-BC)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:MARY
Last Name:WALSH
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:535 E 70TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4898
Mailing Address - Country:US
Mailing Address - Phone:516-941-2039
Mailing Address - Fax:516-222-6893
Practice Address - Street 1:333 EARLE OVINGTON BLVD
Practice Address - Street 2:
Practice Address - City:UNIONDALE
Practice Address - State:NY
Practice Address - Zip Code:11553-3610
Practice Address - Country:US
Practice Address - Phone:516-941-2039
Practice Address - Fax:516-222-6893
Is Sole Proprietor?:No
Enumeration Date:2010-10-28
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY305344363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health