Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 170615-1 | NY |
NPI | 1023154069 |
---|---|
Provider Name | Dr. Daniel Horacio Wasserman |
First Address | Forest Hills, NY 11375-5550 |
Second Address | Forest Hills, NY 11375-5550 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01078399 | (05) | NY |
E4114 | (02) | NY |