# TODD R WALDORF DO PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114543287
- **Authorized official:** DR. TODD ROBERT WALDORF D.O. (OWNER / PHYSICIAN)
- **Authorized official phone:** (518) 526-9996

## Contact information

- **Practice address:** 555 BREED HILL ROAD, CROWN POINT, NY 12928-1731
- **Practice address phone:** (518) 526-9996
- **Practice address fax:** (518) 240-4172
- **Mailing address:** 555 BREED HILL ROAD, CROWN POINT, NY 12928-1731
- **Mailing address phone:** (518) 526-9996
- **Mailing address fax:** (518) 240-4172

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204D00000X | Neuromusculoskeletal Medicine & OMM Physician | — | NULL | — |
| 204D00000X | Neuromusculoskeletal Medicine & OMM Physician | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 208M00000X | Hospitalist Physician | — | NULL | — |
| 208M00000X | Hospitalist Physician | — | — | — |

## Other

- **Enumeration date:** 06/24/2020
- **Last updated:** 06/24/2020