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General NPI Number Information
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NPI Number | 1962671214
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Entity Type | Organization
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Legal Business Name | MIDDLESEX THORACIC MEDICAL GROUP
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Dates
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Enumeration Date | 02/20/2008
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Last Update Date | 03/14/2008
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Provider Practice Location Address
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Address Line | 58 VALLEY FORGE DR
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-3278
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Country | US
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Telephone | 732-698-7344
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Fax | 413-513-7664
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Provider Business Mailing Address
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Address Line | 58 VALLEY FORGE DR
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-3278
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Country | US
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Telephone | 732-698-7344
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Fax | 413-513-7664
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Authorized Official
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Title or Position | OWNER
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Name | DR. HOWARD KENNETH WAKSMAN
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Credential | MD
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Telephone | 732-698-7344
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | MA70513
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License Number State | NJ
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