Provider Demographics
NPI:1912215013
Name:WAYNE J. ALTMAN, M.D. P.A.
Entity Type:Organization
Organization Name:WAYNE J. ALTMAN, M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:J
Authorized Official - Last Name:ALTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:291-438-5888
Mailing Address - Street 1:85 ORIENT WAY
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-2070
Mailing Address - Country:US
Mailing Address - Phone:201-438-5888
Mailing Address - Fax:201-438-6825
Practice Address - Street 1:85 ORIENT WAY
Practice Address - Street 2:1ST FLOOR
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-2070
Practice Address - Country:US
Practice Address - Phone:201-438-5888
Practice Address - Fax:201-438-6825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA36854174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty