Healthcare Provider Details

I. General information

NPI: 1467434613
Provider Name (Legal Business Name): MICHAEL E WALDMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 RYKOWSKI LN STE 101
MIDDLETOWN NY
10941-4055
US

IV. Provider business mailing address

185 RYKOWSKI LN STE 101
MIDDLETOWN NY
10941-4055
US

V. Phone/Fax

Practice location:
  • Phone: 845-692-0030
  • Fax: 845-692-0037
Mailing address:
  • Phone: 845-692-0030
  • Fax: 845-692-0037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number036250
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number036250
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number036250
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number036250
License Number StateCT
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036250
License Number StateCT
# 6
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number036250
License Number StateCT
# 7
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number036250
License Number StateCT
# 8
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number226895
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: