MEDICARE: PAUL F WATERS MD LLC

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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	213723	NY

General Provider Information

NPI Number	:	1750313458
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAUL F WATERS MD LLC

Provider Business Mailing Address
First Line	:	55 MAMARONECK RD
Second Line	:
City	:	SCARSDALE
State	:	NY
Zip	:	10583-2823
Country	:	US
Telephone Number	:	203-863-4341
Fax Number	:	203-863-4249

Provider Business Practice Location Address
First Line	:	170 W 12TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10011-8202
Country	:	US
Telephone Number	:	203-863-4341
Fax Number	:	203-863-4249

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	JEANNINE RACITI
Credential	:	MD
Telephone Number	:	914-771-7335

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	12/10/2012

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