Individual
KENNETH A WALSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
325 PARK AVE, HUNTINGTON, NY 11743-2779
(631) 351-3782
(631) 351-3729
Mailing address
325 PARK AVE, HUNTINGTON, NY 11743-2779
(631) 351-3782
(631) 351-3729
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
161747-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00906670
—
NY
01
—
2595080
GHI
NY
01
—
2C4894
HEALTHNET
NY
01
—
41D641
BLUE CROSS/ BLUE SHIELD
NY
01
—
CP087
OXFORD
NY
Enumeration date
07/31/2006
Last updated
07/02/2008
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