MEDICARE: MARC WALDMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	N004922	NY
2	213EP1101X	Primary Podiatric Medicine Podiatrist	N004922	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366419236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARC WALDMAN

Provider Business Mailing Address
First Line	:	9020 ELMHURST AVE
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-7936
Country	:	US
Telephone Number	:	718-397-9800
Fax Number	:	718-397-0731

Provider Business Practice Location Address
First Line	:	9020 ELMHURST AVE
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-7936
Country	:	US
Telephone Number	:	718-397-9800
Fax Number	:	718-397-0731

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2006
Last Update Date	:	06/16/2008

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Directions to “ MARC WALDMAN ” Practice Location

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