Individual provider Active NPI

Andrea Jeanne Walter, M.D.

  • Psychiatry Physician
  • New Providence, NJ
National Provider Identifier
1457330417
Registry record updated May 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
25MA08994300 Issued in NJ
Practice address
890 Mountain Ave
New Providence, NJ 07974-1218
Phone
(908) 277-8900
Fax
(908) 508-8919
NPI assigned
Jan 10, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 8, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 210161 MA
Psychiatry Physician 2084P0800X 229271 NY
Psychiatry Physician 2084P0800X 25MA08994300 NJ Primary

Addresses

Primary practice location

890 Mountain Ave
New Providence, NJ 07974-1218

Mailing address

113 Merritt Dr
Oradell, NJ 07649-1822
Phone (917) 855-2511

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120601000040 NJ Practitioner - Psychiatry 9335134535 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
210161MAMDPsychiatry Physician
229271NYMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Immediate Care Psychiatric Center Psychiatry CurrentSince Nov 20, 2019 Accepting new patients
Summit Medical Group PA CurrentSince Apr 22, 2024 Accepting new patients
Summit Medical Group PA CurrentSince Apr 22, 2024 Accepting new patients
President & Fellows of Harvard College Past Accepting new patients

Locations

1 Diamond Hill Rd
Berkeley Heights, NJ 07922
Phone (908) 277-8868

30 Prospect Ave
Hackensack, NJ 07601
Phone (201) 488-0066

890 Mountain Ave
New Providence, NJ 07974
Phone (908) 277-8799

150 Floral Ave
New Providence, NJ 07974
Phone (908) 588-3890

Interoperability endpoints

  • Direct secure messaging: andrea.walter.1@2983.direct.athenahealth.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1136851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715126400000",
    "number": "1457330417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 MERRITT DR",
            "city": "ORADELL",
            "state": "NJ",
            "postal_code": "076491822",
            "telephone_number": "917-855-2511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "890 MOUNTAIN AVE",
            "city": "NEW PROVIDENCE",
            "state": "NJ",
            "postal_code": "079741218",
            "telephone_number": "908-277-8900",
            "fax_number": "908-508-8919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTER",
        "first_name": "ANDREA",
        "middle_name": "JEANNE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-10",
        "last_updated": "2024-05-08",
        "certification_date": "2024-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MA",
            "license": "210161",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "229271",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NJ",
            "license": "25MA08994300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Providence, NJ

Sources for this page

Verify at the official NPI Registry.