Provider Demographics
NPI:1003056268
Name:WASSERMAN, AMY MICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:MICHELLE
Last Name:WASSERMAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:19 BRADHURST AVE
Mailing Address - Street 2:SUITE 3070N
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-2140
Mailing Address - Country:US
Mailing Address - Phone:914-372-7887
Mailing Address - Fax:914-372-7884
Practice Address - Street 1:19 BRADHURST AVE
Practice Address - Street 2:SUITE 3070N
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-2140
Practice Address - Country:US
Practice Address - Phone:914-372-7887
Practice Address - Fax:914-372-7884
Is Sole Proprietor?:No
Enumeration Date:2009-03-01
Last Update Date:2015-03-26
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Provider Licenses
StateLicense IDTaxonomies
MA239748207R00000X
CAA97716207RR0500X
NY278234207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110082710AMedicaid
MA001160901Medicare PIN