Physician Compare National (NPI:1437129665)

HEALTHCARE PROVIDER: JEREMY WALDMAN M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1437129665
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0648282475
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20070926000419
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	WALDMAN
	Individual professional last name
Provider First Name	JEREMY
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	STATE UNIVERSITY OF NEW YORK AT STONY BROOK, SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	2001
	Individual professional's medical school graduation year
Primary Specialty	PHYSICAL MEDICINE AND REHABILITATION
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	WALDMAN PLASTIC SURGERY AND DERMATOLOGY, PLLC
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	7618061300
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	2
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	17 RIVERSIDE ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 105
	Group Practice or individual's line 2 address
City	NASHUA
	Group Practice or individual's city
State	NH
	Group Practice or individual's state
Zip Code	030621383
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6035775559
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	300011
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ST JOSEPH HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y