Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mr. Idan Aviv Waksman, PA-C

Individual provider Physician Assistant · NPI 1457991903

Mr. Idan Aviv Waksman, PA-C is a Physician Assistant in Philadelphia, Pennsylvania. Qualified in 2019, 7 years ago. Practices with Haddon Emergency Physicians LLC, a 21-clinician group, works from 6 locations and accepts Medicare assignment. Licensed in New Jersey and Pennsylvania.

Years since qualifying
7
Licensed in
NJ, PA
In the registry since
2020
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

3400 Spruce Street Ground Silverstein Bldg
Philadelphia, PA 19104-4206
Phone: (617) 633-6414
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (5)

  • 1600 Haddon Ave, Camden, NJ 08103-3101 — (856) 757-3500
  • 90 Brick Rd Fl 3, Marlton, NJ 08053-2177 — (856) 355-6000
  • 175 Madison Ave, Mount Holly, NJ 08060-2038 — (609) 914-6000
  • 100 Bowman Dr Lowr Level1, Voorhees, NJ 08043-9612 — (856) 247-3000
  • 218 Sunset Rd Fl 5, Willingboro, NJ 08046-1110 — (609) 835-3056

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence MA061390 (PA)
Physician Assistant Taxonomy 363A00000X · Licence 25MP00556700 (NJ)

Record details

NPI number1457991903
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedJanuary 13, 2020
Last updated in NPPESApril 17, 2026
Certification dateApril 17, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Haddon Emergency Physicians Llc — 21 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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