Provider Demographics
NPI:1447304183
Name:WALDORF DERMATOLOGY & LASER ASSOCIATES, P.C.
Entity type:Organization
Organization Name:WALDORF DERMATOLOGY & LASER ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:WALDORF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-623-7077
Mailing Address - Street 1:57 NORTH MIDDLETOWN ROAD
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954
Mailing Address - Country:US
Mailing Address - Phone:845-623-7077
Mailing Address - Fax:845-623-2108
Practice Address - Street 1:57 NORTH MIDDLETOWN ROAD
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954
Practice Address - Country:US
Practice Address - Phone:845-623-7077
Practice Address - Fax:845-623-2108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WEE821Medicare PIN