Provider Demographics
NPI:1962671214
Name:MIDDLESEX THORACIC MEDICAL GROUP
Entity Type:Organization
Organization Name:MIDDLESEX THORACIC MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:WAKSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-698-7344
Mailing Address - Street 1:58 VALLEY FORGE DR
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-3278
Mailing Address - Country:US
Mailing Address - Phone:732-698-7344
Mailing Address - Fax:413-513-7664
Practice Address - Street 1:58 VALLEY FORGE DR
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-3278
Practice Address - Country:US
Practice Address - Phone:732-698-7344
Practice Address - Fax:413-513-7664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA70513207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty