Healthcare Provider Details

I. General information

NPI: 1891632055
Provider Name (Legal Business Name): JOSEPH WAXMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 40TH ST
BROOKLYN NY
11218-3510
US

IV. Provider business mailing address

1450 40TH ST
BROOKLYN NY
11218-3510
US

V. Phone/Fax

Practice location:
  • Phone: 718-854-1800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number912314
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: