Provider Demographics
NPI:1902095854
Name:WAKSLAK, MENACHEM (MD)
Entity Type:Individual
Prefix:
First Name:MENACHEM
Middle Name:
Last Name:WAKSLAK
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 1:16119 VANOWEN ST
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-4822
Mailing Address - Country:US
Mailing Address - Phone:818-904-6782
Mailing Address - Fax:818-904-5896
Practice Address - Street 1:16119 VANOWEN ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-4822
Practice Address - Country:US
Practice Address - Phone:818-904-6782
Practice Address - Fax:818-904-5896
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY240477-1207RC0000X, 207RC0001X
CAA114088207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease