Individual
DR. WAYNE WALTZER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
24 RESEARCH WAY, SUITE 500, EAST SETAUKET, NY 11733-3453
(631) 444-6270
Mailing address
PO BOX 1559, STONY BROOK, NY 11790-0989
(631) 444-6270
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
139086
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00496066
—
NY
01
—
0388S2
EMPIRE B/C B/S
NY
01
—
4401701
AETNA
NY
Enumeration date
06/27/2006
Last updated
07/08/2007
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