Basic Information
Provider Information
NPI: 1003800723
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WALCZYK
FirstName: ARTHUR
MiddleName: G
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 111 CLOCK TOWER CMNS
Address2:  
City: BREWSTER
State: NY
PostalCode: 105094055
CountryCode: US
TelephoneNumber: 8455924915
FaxNumber:  
Practice Location
Address1: 159 BARNEGAT RD FL 2
Address2:  
City: POUGHKEEPSIE
State: NY
PostalCode: 126015401
CountryCode: US
TelephoneNumber: (845) 452-9800
FaxNumber: 8454527691
Other Information
ProviderEnumerationDate: 09/08/2005
LastUpdateDate: 03/17/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RG0100X174866NYY Allopathic & Osteopathic PhysiciansInternal MedicineGastroenterology

ID Information
IDTypeStateIssuerDescription
AW03V6991001NYEMPIRE BLUE CROSS BLUE SHIELDOTHER
0192123705NY MEDICAID


Home