MEDICARE: DR. BRIAN J WALDRON DO

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	207Q00000X	Family Medicine Physician	1673501	NY
2	204D00000X	Neuromusculoskeletal Medicine & OMM Physician	167350	NY

General Provider Information

NPI Number	:	1093785651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN J WALDRON DO

Provider Business Mailing Address
First Line	:	61 BROADWAY
Second Line	:	STE 910
City	:	NEW YORK
State	:	NY
Zip	:	10006-2736
Country	:	US
Telephone Number	:	212-344-5361
Fax Number	:	212-514-5460

Provider Business Practice Location Address
First Line	:	61 BROADWAY
Second Line	:	STE 910
City	:	NEW YORK
State	:	NY
Zip	:	10006-2736
Country	:	US
Telephone Number	:	212-344-5361
Fax Number	:	212-514-5460

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

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	01/27/2014

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