Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 299420 | NY |
N | 207VG0400X | Gynecologist | 299420 | NY |
N | 207VX0000X | Obstetrician | 299420 | NY |
NPI | 1063806552 |
---|---|
Provider Name | Krista Lynn Wasserman |
First Address | Westbury, NY 11590-5114 |
Second Address | Woodbury, NY 11797-2038 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2015 |
Last Update Date | 03/12/2019 |