MEDICARE: MARTIN BRUCE WAX MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207WX0009X	Glaucoma Specialist (Ophthalmology) Physician	284054-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033267893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTIN BRUCE WAX MD

Provider Business Mailing Address
First Line	:	NYU LANGONE MEDICAL CENTER
Second Line	:	222 EAST 41ST
City	:	NEW YORK
State	:	NY
Zip	:	10017
Country	:	US
Telephone Number	:	212-263-2573
Fax Number	:

Provider Business Practice Location Address
First Line	:	41 BRANCH RD
Second Line	:
City	:	FAR HILLS
State	:	NJ
Zip	:	07931-2240
Country	:	US
Telephone Number	:	817-966-3069
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	09/25/2019

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