Individual
MR. DENNIS WAXMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
111 SULLIVAN AVE, FERNDALE, NY 12734-4315
(845) 292-6630
(845) 794-9868
Mailing address
PO BOX 421, CRMC PHYSICIAN SERVICES, HARRIS, NY 12742-0421
(845) 794-9864
(845) 794-9868
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
001355
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01969891
—
NY
Enumeration date
09/27/2006
Last updated
04/14/2008
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