Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | N004922 | NY |
Y | 222Z00000X | Podiatrist | N004922 | NY |
N | 213EP1101X | Primary Podiatric Medicine | N004922 | NY |
NPI | 1366419236 |
---|---|
Provider Name | Marc Waldman |
First Address | Jackson Heights, NY 11372-7936 |
Second Address | Jackson Heights, NY 11372-7936 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2006 |
Last Update Date | 16/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01524478 | (05) | NY |
U43765 | (02) | NY |