Healthcare Provider Details

I. General information

NPI: 1912215013
Provider Name (Legal Business Name): WAYNE J. ALTMAN, M.D. P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2010
Last Update Date: 09/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 ORIENT WAY 1ST FLOOR
RUTHERFORD NJ
07070-2070
US

IV. Provider business mailing address

85 ORIENT WAY 1ST FLOOR
RUTHERFORD NJ
07070-2070
US

V. Phone/Fax

Practice location:
  • Phone: 201-438-5888
  • Fax: 201-438-6825
Mailing address:
  • Phone: 201-438-5888
  • Fax: 201-438-6825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA36854
License Number StateNJ

VIII. Authorized Official

Name: DR. WAYNE J ALTMAN
Title or Position: OWNER
Credential: M.D.
Phone: 291-438-5888