MEDICARE: WAYNE J. ALTMAN, M.D. P.A.

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	174400000X	Specialist	MA36854	NJ

General Provider Information

NPI Number	:	1912215013
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAYNE J. ALTMAN, M.D. P.A.

Provider Business Mailing Address
First Line	:	85 ORIENT WAY
Second Line	:	1ST FLOOR
City	:	RUTHERFORD
State	:	NJ
Zip	:	07070-2070
Country	:	US
Telephone Number	:	201-438-5888
Fax Number	:	201-438-6825

Provider Business Practice Location Address
First Line	:	85 ORIENT WAY
Second Line	:	1ST FLOOR
City	:	RUTHERFORD
State	:	NJ
Zip	:	07070-2070
Country	:	US
Telephone Number	:	201-438-5888
Fax Number	:	201-438-6825

Authorized Official
Title or Position	:	OWNER
Name	:	DR. WAYNE J ALTMAN
Credential	:	M.D.
Telephone Number	:	291-438-5888

Provider Enumeration Date	:	09/23/2010
Last Update Date	:	09/23/2010

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