Healthcare Provider Details

I. General information

NPI: 1346290715
Provider Name (Legal Business Name): DR. LEE MICHAEL WALDMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 CLARKSON AVE DEPARTMENT OF PEDIATRICS
BROOKLYN NY
11203-2057
US

IV. Provider business mailing address

53 WINSTON ST
STATEN ISLAND NY
10312-1342
US

V. Phone/Fax

Practice location:
  • Phone: 718-245-2982
  • Fax: 718-245-2157
Mailing address:
  • Phone: 791-784-2909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number205881
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: