Medina, Walter Andrew
Medina, Walter Andrew is an sole proprietor health care provider with primary practice located at 6370 110Th St , Forest Hills NY 11375-1440. He recently has only one registered license in Allopathic & Osteopathic Physicians / General Practice, which is considered as his primary health care specialty. Medina, Walter Andrew can be contacted via phone (718) 833-8052.Contact Information
Primary practice address
6370 110Th St
Forest Hills NY 11375-1440
Phone: (718) 833-8052
Fax: (718) 833-8968
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / General Practice | 208D00000X | 206169 | New York |
Profile Details
| NPI number | 1336163179 |
|---|---|
| LBN Legal business name | Medina, Walter Andrew |
| Credentials | Doctor of Osteopathy (DO) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jul 26th, 2006 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1336163179 | NPPES |
| New York | MEDICAID | 01744632 |
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