Healthcare Provider Details

I. General information

NPI: 1033267893
Provider Name (Legal Business Name): MARTIN BRUCE WAX MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 09/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 BRANCH RD
FAR HILLS NJ
07931-2240
US

IV. Provider business mailing address

NYU LANGONE MEDICAL CENTER 222 EAST 41ST
NEW YORK NY
10017
US

V. Phone/Fax

Practice location:
  • Phone: 817-966-3069
  • Fax:
Mailing address:
  • Phone: 212-263-2573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number284054-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: