Active NPI
Andrea Jeanne Walter, M.D.
- Psychiatry Physician
- New Providence, NJ
National Provider Identifier
1457330417
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 25MA08994300
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
Enrollment records 1
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.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 210161 | MA | MD | Psychiatry Physician |
| 229271 | NY | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Immediate Care Psychiatric Center | Psychiatry | Current | Accepting new patients |
| Summit Medical Group PA | Current | Accepting new patients | |
| Summit Medical Group PA | Current | 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
- 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.
-
- Psychiatry Physician
- Parsippany, NJ
- NPI 1124072632
-
- Multi-Specialty Clinic/Center
- Berkeley Heights, NJ
- NPI 1942254347
-
- Durable Medical Equipment & Medical Supplies
- Hackensack, NJ
- NPI 1043930555
-
- Multi-Specialty Clinic/Center
- Cambridge, MA
- NPI 1952366312
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.