Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 239748 | MA |
N | 111NI0900X | Internist | 239748 | MA |
Y | 207RR0500X | Rheumatology | 278234 | NY |
N | 207RR0500X | Rheumatology | A97716 | CA |
NPI | 1003056268 |
---|---|
Provider Name | Dr. Amy Michelle Wasserman |
First Address | Hawthorne, NY 10532-2140 |
Second Address | Hawthorne, NY 10532-2140 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2009 |
Last Update Date | 26/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110082710A | (05) | MA |