Healthcare Provider Details

I. General information

NPI: 1245292309
Provider Name (Legal Business Name): ANDREW M WAKSTEIN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 01/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 FRANKLIN AVE SUITE 5
PALMERTON PA
18071-1509
US

IV. Provider business mailing address

217 FRANKLIN AVE SUITE 5
PALMERTON PA
18071-1509
US

V. Phone/Fax

Practice location:
  • Phone: 610-824-5050
  • Fax: 610-824-5053
Mailing address:
  • Phone: 610-824-5050
  • Fax: 610-824-5053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License NumberOS008560L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: