Healthcare Provider Details

I. General information

NPI: 1952373466
Provider Name (Legal Business Name): STEVEN WAXENBAUM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 ENGLE ST
ENGLEWOOD NJ
07631-2444
US

IV. Provider business mailing address

216 ENGLE ST
ENGLEWOOD NJ
07631-2444
US

V. Phone/Fax

Practice location:
  • Phone: 201-567-7615
  • Fax: 201-567-8033
Mailing address:
  • Phone: 201-567-7615
  • Fax: 201-567-8033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMA060653
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number25MA06065300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: