Provider Demographics
NPI:1174595417
Name:WALSKY, ROBERT S (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:WALSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:452 OLD HOOK RD
Mailing Address - Street 2:STE 302
Mailing Address - City:EMERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07630
Mailing Address - Country:US
Mailing Address - Phone:201-967-1105
Mailing Address - Fax:201-967-1272
Practice Address - Street 1:452 OLD HOOK RD
Practice Address - Street 2:STE 302
Practice Address - City:EMERSON
Practice Address - State:NJ
Practice Address - Zip Code:07630
Practice Address - Country:US
Practice Address - Phone:201-967-1105
Practice Address - Fax:201-967-1272
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJM30105208600000X
NY1103181208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2919001Medicaid
NJ2919001Medicaid
NJWA459959Medicare ID - Type Unspecified