Provider Demographics
NPI:1710173828
Name:DR JOHN WAT, DABFM, P.C.
Entity Type:Organization
Organization Name:DR JOHN WAT, DABFM, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:WAT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:646-284-6072
Mailing Address - Street 1:2510 ROUTE 44
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SALT POINT
Mailing Address - State:NY
Mailing Address - Zip Code:12578-8040
Mailing Address - Country:US
Mailing Address - Phone:845-677-3617
Mailing Address - Fax:845-677-3731
Practice Address - Street 1:2510 ROUTE 44
Practice Address - Street 2:SUITE 6
Practice Address - City:SALT POINT
Practice Address - State:NY
Practice Address - Zip Code:12578-8040
Practice Address - Country:US
Practice Address - Phone:845-677-3617
Practice Address - Fax:845-677-3731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230325207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty