Organization
EHMETH MEDICAL SERVICES, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAMUEL R WALTERS M.D. (INTERNIST)
(718) 364-3322
Entity
Organization
Contact information
Practice address
3130 GRAND CONCOURSE, SUITE B5, BRONX, NY 10458-1213
(718) 364-3322
(718) 364-2790
Mailing address
13876 QUEENS BLVD, 1ST FLOOR, BRIARWOOD, NY 11435-2930
(718) 850-6345
(718) 559-4895
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
115662
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00213896
—
NY
01
—
A300024689
MEDICARE EMPIRE
NY
01
—
G300013444
MEDICARE GHI
NY
Enumeration date
09/13/2010
Last updated
09/16/2010
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