Healthcare Provider Details

I. General information

NPI: 1376541862
Provider Name (Legal Business Name): SAMUEL WAXMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 5TH AVE
NEW YORK NY
10128-0724
US

IV. Provider business mailing address

1150 5TH AVE
NEW YORK NY
10128-0724
US

V. Phone/Fax

Practice location:
  • Phone: 212-289-2828
  • Fax: 212-860-9134
Mailing address:
  • Phone: 212-289-2828
  • Fax: 212-860-9134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number092748
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: