Healthcare Provider Details

I. General information

NPI: 1528471687
Provider Name (Legal Business Name): EPHRAIM WAKSZUL PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2014
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 ROUTE 59
SPRING VALLEY NY
10977-5231
US

IV. Provider business mailing address

175 ROUTE 59
SPRING VALLEY NY
10977-5231
US

V. Phone/Fax

Practice location:
  • Phone: 845-694-8888
  • Fax: 845-200-3088
Mailing address:
  • Phone: 845-694-8888
  • Fax: 845-200-3088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number23 017623
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00336900
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number3330
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3330
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: