Individual
AMANDA WASSERMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
210 E 64TH ST, NEW YORK, NY 10065-7471
(973) 303-6946
(646) 785-8121
Mailing address
210 E 64TH ST, NEW YORK, NY 10065-7471
(973) 303-6946
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
032028
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
032028
NY STATE LICENSE
NY
01
—
25MP00863400
NEW JERSEY STATE LICENSE
NJ
Enumeration date
06/12/2024
Last updated
09/09/2024
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