Individual
DR. MARK DAVID WASSERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
555 ROUTE 25A, MILLER PLACE, NY 11764-2625
(631) 744-6666
(631) 744-0525
Mailing address
555 ROUTE 25A, MILLER PLACE, NY 11764-2625
(631) 744-6666
(631) 744-0525
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
132521
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00651661
—
NY
Enumeration date
04/27/2006
Last updated
02/28/2008
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