MEDICARE: DR. MARK STEVEN WAXMAN 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	207RG0100X	Gastroenterology Physician	25MA03630700	NJ
2	207R00000X	Internal Medicine Physician	25MA03630700	NJ

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	:	1396719894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK STEVEN WAXMAN MD

Provider Business Mailing Address
First Line	:	15 MCDONOUGH PL
Second Line	:
City	:	WEST CALDWELL
State	:	NJ
Zip	:	07006-4226
Country	:	US
Telephone Number	:	973-228-9171
Fax Number	:	201-997-6610

Provider Business Practice Location Address
First Line	:	312 BELLEVILLE TPKE
Second Line	:	SUITE 1B
City	:	NORTH ARLINGTON
State	:	NJ
Zip	:	07031-6463
Country	:	US
Telephone Number	:	201-997-6776
Fax Number	:	201-997-6610

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

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	06/16/2018

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