MEDICARE: JEFFREY WACKS M.D.

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	207Q00000X	Family Medicine Physician	264941	MA

General Provider Information

NPI Number	:	1568708311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY WACKS M.D.

Provider Business Mailing Address
First Line	:	117 W CENTRAL ST
Second Line	:
City	:	NATICK
State	:	MA
Zip	:	01760-4381
Country	:	US
Telephone Number	:	508-318-6941
Fax Number	:	508-318-6417

Provider Business Practice Location Address
First Line	:	117 W CENTRAL ST
Second Line	:
City	:	NATICK
State	:	MA
Zip	:	01760-4381
Country	:	US
Telephone Number	:	508-318-6941
Fax Number	:	508-318-6417

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

Provider Enumeration Date	:	12/26/2012
Last Update Date	:	03/01/2016

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