Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 137689 | NY |
NPI | 1003825456 |
---|---|
Provider Name | Raymond Barry Walsh |
First Address | Brooklyn, NY 11209-1502 |
Second Address | Brooklyn, NY 11209-1502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00856946 | (05) | NY |
C05319 | (02) | NY |