Provider Demographics
NPI:1093703654
Name:WALTZMAN, ROGER J (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:J
Last Name:WALTZMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:310 EAST 67 STREET
Mailing Address - Street 2:SUITE 1-8
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065
Mailing Address - Country:US
Mailing Address - Phone:917-262-0415
Mailing Address - Fax:212-409-8271
Practice Address - Street 1:310 EAST 67 STREET
Practice Address - Street 2:SUITE 1-8
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065
Practice Address - Country:US
Practice Address - Phone:917-262-0415
Practice Address - Fax:212-409-8271
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-07
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY199084207RH0003X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01873638Medicaid
NYG78537Medicare UPIN
NY01873638Medicaid