Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 028681 | CT |
NPI | 1023016011 |
---|---|
Provider Name | Dr. Eric L Wasserman |
First Address | Stamford, CT 06905-5359 |
Second Address | Stamford, CT 06905-5359 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2005 |
Last Update Date | 15/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
180000379 | PTAN (01) | CT |
C23196 | (02) | CT |