MEDICARE: DR. MARC DAVID WALDMAN M.D.

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	2084P0800X	Psychiatry Physician	183880	NY

General Provider Information

NPI Number	:	1790881043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARC DAVID WALDMAN M.D.

Provider Business Mailing Address
First Line	:	P.O. BOX 612
Second Line	:
City	:	CROSS RIVER
State	:	NY
Zip	:	10518-0612
Country	:	US
Telephone Number	:	914-763-6119
Fax Number	:

Provider Business Practice Location Address
First Line	:	892 ROUTE 35
Second Line	:
City	:	CROSS RIVER
State	:	NY
Zip	:	10518-1141
Country	:	US
Telephone Number	:	914-763-6119
Fax Number	:

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

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	12/19/2011

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