Individual
DR. CLARENCE L WALTROUS JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
63 PENNSYLVANIA AVE, BROOKLYN, NY 11207-2405
(646) 317-0720
Mailing address
867 DUNCAN DR, WESTBURY, NY 11590-1404
(646) 317-0720
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
134427
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01535928
—
NY
01
—
2488517
US HEALTHCARE, AETNA
NY
01
—
P2119500
OXFORD
NY
Enumeration date
07/28/2006
Last updated
07/15/2015
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