Provider Demographics
NPI:1528114758
Name:WALSH-BRUNETTI LLC
Entity type:Organization
Organization Name:WALSH-BRUNETTI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:THORNLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-661-9439
Mailing Address - Street 1:31 RIVER RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COS COB
Mailing Address - State:CT
Mailing Address - Zip Code:06807-2152
Mailing Address - Country:US
Mailing Address - Phone:203-661-9433
Mailing Address - Fax:203-661-2918
Practice Address - Street 1:31 RIVER RD
Practice Address - Street 2:SUITE 200
Practice Address - City:COS COB
Practice Address - State:CT
Practice Address - Zip Code:06807-2152
Practice Address - Country:US
Practice Address - Phone:203-661-9433
Practice Address - Fax:203-661-2918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT207RN0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC03016Medicare ID - Type UnspecifiedCT MEDICARE
DA3437Medicare ID - Type UnspecifiedRAILROAD MEDICARE