Provider Demographics
NPI:1952373466
Name:WAXENBAUM, STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:
Last Name:WAXENBAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 ENGLE ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2444
Mailing Address - Country:US
Mailing Address - Phone:201-567-7615
Mailing Address - Fax:201-567-8033
Practice Address - Street 1:216 ENGLE ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2444
Practice Address - Country:US
Practice Address - Phone:201-567-7615
Practice Address - Fax:201-567-8033
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06065300208C00000X
NJMA060653208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6392806Medicaid
NJ20051753OtherMEDICARE RAILROAD
NJ6392806Medicaid
NJ082470AXVMedicare ID - Type Unspecified