MEDICARE: DR. LARRY WALDMAN

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	1223G0001X	General Practice Dentistry	028508	NY

General Provider Information

NPI Number	:	1568563815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LARRY WALDMAN

Provider Business Mailing Address
First Line	:	419 E MAIN ST
Second Line	:	SUITE 202
City	:	MIDDLETOWN
State	:	NY
Zip	:	10940-2552
Country	:	US
Telephone Number	:	845-343-1533
Fax Number	:	845-343-2109

Provider Business Practice Location Address
First Line	:	419 E MAIN ST
Second Line	:	SUITE 202
City	:	MIDDLETOWN
State	:	NY
Zip	:	10940-2552
Country	:	US
Telephone Number	:	845-343-1533
Fax Number	:	845-343-2109

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

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	07/08/2007

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