Provider Demographics
NPI:1730117466
Name:WALSH, TIMOTHY ALOYSIUS (ATC,LAT)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:ALOYSIUS
Last Name:WALSH
Suffix:
Gender:M
Credentials:ATC,LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 FAIRFIELD CT
Mailing Address - Street 2:
Mailing Address - City:TOWNSHIP OF WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07676-5114
Mailing Address - Country:US
Mailing Address - Phone:201-248-3519
Mailing Address - Fax:201-935-5149
Practice Address - Street 1:390 MURRAY HILL PKWY
Practice Address - Street 2:
Practice Address - City:EAST RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07073-2109
Practice Address - Country:US
Practice Address - Phone:201-635-3192
Practice Address - Fax:201-935-5149
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT00021200174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist