Provider Demographics
NPI:1255306924
Name:SETH WALDMAN MD PC
Entity Type:Organization
Organization Name:SETH WALDMAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PRINCIPAL
Authorized Official - Prefix:MR
Authorized Official - First Name:SETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:WALDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-606-1686
Mailing Address - Street 1:PO BOX 7025
Mailing Address - Street 2:
Mailing Address - City:AMAGANSETT
Mailing Address - State:NY
Mailing Address - Zip Code:11930-7025
Mailing Address - Country:US
Mailing Address - Phone:631-329-6925
Mailing Address - Fax:631-329-9651
Practice Address - Street 1:535 EAST 70TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4872
Practice Address - Country:US
Practice Address - Phone:212-606-1686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-17
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9L0831OtherBLUE CROSS BLUE SHIELD
230054100OtherFED WORKERS COMPENSATION