Provider Demographics
NPI:1649440447
Name:ALBERT WACHA DPM
Entity type:Organization
Organization Name:ALBERT WACHA DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:WACHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-226-4848
Mailing Address - Street 1:31 SMULL AVE
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-5011
Mailing Address - Country:US
Mailing Address - Phone:973-226-4848
Mailing Address - Fax:973-226-7529
Practice Address - Street 1:31 SMULL AVE
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-5011
Practice Address - Country:US
Practice Address - Phone:973-226-4848
Practice Address - Fax:973-226-7529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00116900335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT44741Medicare UPIN
NJ126081Medicare PIN
NJ0813620001Medicare NSC