Provider Demographics
NPI:1285785006
Name:ALTARRIBA-WALSH, ANA LUCIA (DDS)
Entity type:Individual
Prefix:DR
First Name:ANA
Middle Name:LUCIA
Last Name:ALTARRIBA-WALSH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 JONATHAN DR
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08721-1279
Mailing Address - Country:US
Mailing Address - Phone:212-928-2900
Mailing Address - Fax:212-928-2911
Practice Address - Street 1:601-W. 176 ST.
Practice Address - Street 2:SUITE 1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033
Practice Address - Country:US
Practice Address - Phone:212-928-2900
Practice Address - Fax:212-928-2911
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050948122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02524954Medicaid