Provider Demographics
NPI:1063410470
Name:WALTER, ERIC G (DPM)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:G
Last Name:WALTER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 E 233RD ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-2604
Mailing Address - Country:US
Mailing Address - Phone:718-920-2060
Mailing Address - Fax:718-920-6889
Practice Address - Street 1:600 E 233RD ST
Practice Address - Street 2:SUITE 3
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-2604
Practice Address - Country:US
Practice Address - Phone:718-920-2060
Practice Address - Fax:718-920-6889
Is Sole Proprietor?:No
Enumeration Date:2005-07-09
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004733213E00000X
NY004733213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01430560Medicaid
NYP5955Medicare PIN
NYU42180Medicare UPIN