Healthcare Provider Details

I. General information

NPI: 1255306924
Provider Name (Legal Business Name): SETH WALDMAN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 01/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 EAST 70TH STREET
NEW YORK NY
10021-4872
US

IV. Provider business mailing address

PO BOX 7025
AMAGANSETT NY
11930-7025
US

V. Phone/Fax

Practice location:
  • Phone: 212-606-1686
  • Fax:
Mailing address:
  • Phone: 631-329-6925
  • Fax: 631-329-9651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. SETH A WALDMAN
Title or Position: OWNER AND PRINCIPAL
Credential: M.D.
Phone: 212-606-1686