# MARK WASSERMAN, MD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1396824306
- **Authorized official:** MARK WASSERMAN MD (MD)
- **Authorized official phone:** (631) 744-6666

## Contact information

- **Practice address:** 555 ROUTE 25A, MILLER PLACE, NY 11764-2625
- **Practice address phone:** (631) 744-6666
- **Practice address fax:** (631) 744-0525
- **Mailing address:** 555 ROUTE 25A, MILLER PLACE, NY 11764-2625
- **Mailing address phone:** (631) 744-6666
- **Mailing address fax:** (631) 744-0525

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 132521 | NY | Yes |

## Other

- **Enumeration date:** 11/02/2006
- **Last updated:** 12/31/2007