NPIMap

Organization Active NPI

Wallace B Kalt MD PC

  • Legal Medicine
  • Massapequa, NY
National Provider Identifier
1043476864
Registry record updated Jul 31, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Legal MedicineTaxonomy code 173000000X
License
077178 Issued in NY
Legal business name
WALLACE B KALT MD PC
Practice address
930 N Broadway
Suite 3
Massapequa, NY 11758-2394
Phone
(516) 798-3110
Fax
(516) 798-3605
NPI assigned
Jul 31, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Wallace B Kalt, MD
Title
Medical Doctor
Phone
(516) 798-3110

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Legal MedicineGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 173000000X 077178 NY Primary

Addresses

Primary practice location

930 N Broadway
Suite 3
Massapequa, NY 11758-2394

Mailing address

930 N Broadway
Suite 3
Massapequa, NY 11758-2394
Phone (516) 798-3110

National Provider Directory

National Provider Directory

Locations

930 N Broadway
Ste 3
North Massapequa, NY 11758
Phone (516) 798-3110

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1217462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217462400000",
    "number": "1043476864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "930 N BROADWAY",
            "address_2": "SUITE 3",
            "city": "MASSAPEQUA",
            "state": "NY",
            "postal_code": "117582394",
            "telephone_number": "516-798-3110",
            "fax_number": "516-798-3605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "930 N BROADWAY",
            "address_2": "SUITE 3",
            "city": "MASSAPEQUA",
            "state": "NY",
            "postal_code": "117582394",
            "telephone_number": "516-798-3110",
            "fax_number": "516-798-3605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALLACE B KALT MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-31",
        "last_updated": "2008-07-31",
        "status": "A",
        "authorized_official_last_name": "KALT",
        "authorized_official_first_name": "WALLACE",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "MEDICAL DOCTOR",
        "authorized_official_telephone_number": "516-798-3110",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "173000000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Legal Medicine",
            "state": "NY",
            "license": "077178",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Massapequa, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.