MR. IDAN WAKSMAN (NPI# 1457991903) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457991903 |
| Entity Type | Individual |
| Full Name | MR. IDAN WAKSMAN |
| Credential | PA-C |
| Practice Address |
1600 Haddon Ave Camden NJ 08103-3101 |
| Practice Telephone | 8567573500 |
| Mailing Telephone | 8567573500 |
| Enumeration Date | 2020-01-13 |
| Last Update Date | 2020-01-24 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 25MP00556700 | NJ | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1600 HADDON AVE |
| City | CAMDEN |
| State | NJ |
| Zip Code | 08103-3101 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851399455 | Christina M Lamonica | Specialist | 1600 Haddon Ave, Camden, NJ 08103-3101 | 2005-07-08 |
| 1992306781 | Eric Rayburn | Nurse Practitioner | 1600 Haddon Ave, Camden, NJ 08103-3101 | 2020-11-06 |
| 1508476177 | Georgeanne V Stilley | Clinical Nurse Specialist | 1600 Haddon Ave, Camden, NJ 08103-3101 | 2020-08-07 |
| 1871125013 | Vanessa Lynn Klemas | Specialist/Technologist, Other | 1600 Haddon Ave, Camden, NJ 08103-3101 | 2020-02-05 |
| 1154964716 | Jaclyn Palmisano | Nurse Practitioner | 1600 Haddon Ave, Camden, NJ 08103-3101 | 2019-10-25 |
| 1538702642 | David Shaw | Anesthesiology | 1600 Haddon Ave, Camden, NJ 08103-3101 | 2019-10-21 |
| 1215588462 | Victoria Clark | Advanced Practice Midwife | 1600 Haddon Ave, Camden, NJ 08103-3101 | 2019-09-27 |
| 1215401120 | Lindsay Szczerbinski | Nurse Anesthetist, Certified Registered | 1600 Haddon Ave, Camden, NJ 08103-3101 | 2019-01-14 |
| 1366919789 | Kassandre King | Nurse Anesthetist, Certified Registered | 1600 Haddon Ave, Camden, NJ 08103-3101 | 2018-10-24 |
| 1104301381 | Julie Lynn Brockway | Nurse Anesthetist, Certified Registered | 1600 Haddon Ave, Camden, NJ 08103-3101 | 2018-10-03 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912516063 | Toni Marie Primas | Registered Nurse | Sheridan Pavilion, Three Cooper Plaza Suite 220, Camden, NJ 08103 | 2020-07-24 |
| 1376028548 | Services To Overcome Drug Abuse Among Teenagers, Inc. | Clinic/Center | 805-815 Federal Street, Camden, NJ 08103 | 2018-10-03 |
| 1942795802 | Kyle Richard Marden | Student in an Organized Health Care Education/Training Program | 401 Haddon Avenue, 2nd Floor Room 266, Camden, NJ 08103 | 2018-06-24 |
| 1588157473 | Julio Antonio Rodriguez Jr. | Student in an Organized Health Care Education/Training Program | Cooper University Hospital, 3 Cooper Plaza Suite 408, Camden, NJ 08103 | 2018-06-14 |
| 1386149748 | Shuchi Gupta | Nurse Practitioner | 519 West Street, Camden, NJ 08103 | 2018-03-28 |
| 1326541491 | Bolanle Idowu-akangbe | Nurse Practitioner | 519-525 West Street, Camden, NJ 08103 | 2018-03-14 |
| 1740709500 | New Beginnings Behavioral Health | Clinic/Center | 1300 Princess Avenue, Camden, NJ 08103 | 2017-09-13 |
| 1760905012 | Loraine Morris | Counselor | 1479 Kaighn Ave, Camden, NJ 08103 | 2017-07-19 |
| 1386164333 | Matthew Share | Genetic Counselor, MS | Two Cooper Plaza, 400 Haddon Avenue, Md Anderson Cancer Center, Camden, NJ 08103 | 2017-06-21 |
| 1568902070 | Cooper University Hospital | General Acute Care Hospital | 1 Cooper Plaza, Dorrance 222, Camden, NJ 08103 | 2017-03-02 |
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| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245634989 | Rebecca Ann Kenderes | Physician Assistant | 5 Masonic Avenue, Camden, NY 13316 | 2014-10-09 |
| 1033402599 | Colonial Family Practice, LLC | Physician Assistant | 1124 Little St, Camden, SC 29020-3613 | 2011-05-17 |
| 1023124161 | Michael Joe Ridley | Physician Assistant | 306 Highway 641 N, Camden, TN 38320-3012 | 2006-08-22 |
| 1073580452 | Jessica C Bethell Barsocchi | Physician Assistant | 3 Cooper Plz Rm 311, Camden, NJ 08103 | 2006-03-03 |
| 1699382440 | David Allen Davidson | Physician Assistant | 353 Cash Rd Sw, Camden, AR 71701-3704 | 2020-09-25 |
| 1346876331 | Amelia Anna Porretta | Physician Assistant | 1 Cooper Plz, Camden, NJ 08103-1461 | 2020-03-21 |
| 1285260828 | Paola Genevieve Suriel | Physician Assistant | 3 Cooper Plz Rm 215, Camden, NJ 08103-1438 | 2020-03-16 |
| 1417583253 | Alyssa Palio | Physician Assistant | 1 Cooper Plz, Camden, NJ 08103-1461 | 2020-03-12 |
| 1003442831 | Patrick Keenan | Physician Assistant | 1 Cooper Plz, Camden, NJ 08103-1461 | 2020-03-12 |
| 1366917338 | Kayla L Mercado | Physician Assistant | 3 Cooper Plz Rm 408, Camden, NJ 08103 | 2018-10-05 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.