Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 52233 | NJ |
N | 111NI0900X | Internist | 52233 | NJ |
Y | 207RG0300X | Geriatric Medicine | 25MA05223300 | NJ |
NPI | 1154394906 |
---|---|
Provider Name | Dr. Jesse V Wassner |
First Address | Baltimore, MD 21228-4664 |
Second Address | Pompton Plains, NJ 07444-2100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2006 |
Last Update Date | 06/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04-74836 | EVERCARE (01) | |
522114204001 | TRICARE (01) | |
7022905 | (05) | NJ |
7726805 | (05) | NJ |
E61142 | (02) |