Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 174866 | NY |
NPI | 1003800723 |
---|---|
Provider Name | Arthur G Walczyk |
First Address | Brewster, NY 10509-4055 |
Second Address | Poughkeepsie, NY 12601-5401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2005 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01921237 | (05) | NY |
AW03V69910 | EMPIRE BLUE CROSS BLUE SHIELD (01) | NY |
D92248 | (02) | NY |