Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | 26NJ00929300 | NJ |
NPI | 1134421530 |
---|---|
Provider Name | Mrs. Abigail Hodges Walsh |
First Address | Montclair, NJ 07043-1903 |
Second Address | Livingston, NJ 07039 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2010 |
Last Update Date | 17/09/2019 |