Theresa Walsh, RPA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

011621 Issued in NY

Practice address

369 E Main St
Suite 3
East Islip, NY 11730-2800

Phone

(631) 581-4500

Fax

(631) 581-5905

NPI assigned

Jan 10, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• North Shore-Lij Medical PC

  • Urology Physician
  • Great Neck, NY
  • NPI 1053688572
  Medicare reassignment

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

{
    "created_epoch": "1294617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1294617600000",
    "number": "1679877419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "369 E MAIN ST",
            "address_2": "SUITE 3",
            "city": "EAST ISLIP",
            "state": "NY",
            "postal_code": "117302800",
            "telephone_number": "631-581-4500",
            "fax_number": "631-581-5905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "369 E MAIN ST",
            "address_2": "SUITE 3",
            "city": "EAST ISLIP",
            "state": "NY",
            "postal_code": "117302800",
            "telephone_number": "631-581-4500",
            "fax_number": "631-581-5905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALSH",
        "first_name": "THERESA",
        "name_prefix": "Ms.",
        "credential": "RPA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-01-10",
        "last_updated": "2011-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "011621",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vikas Desai MD PC
• Laura Volpe
• Suanne Marie Waldron, OTR/L
• Tabitha R Walendowski
• Walgreen Co
• Joyce R. Weaver, M.S.
• Wellness Path Psychiatry
• Connie Sue Weydener, CNA
• Thomas Wieland, MFT
• Michael Vincent Will, MD

• Physician Assistant in East Islip, NY
• Providers in East Islip, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2011; 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.

Verify at the official NPI Registry.