Provider Demographics
NPI:1053310235
Name:WASSERSTEIN, JONATHAN (OD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:WASSERSTEIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 S LIVINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-3014
Mailing Address - Country:US
Mailing Address - Phone:973-758-1151
Mailing Address - Fax:973-758-1152
Practice Address - Street 1:184 S LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-3014
Practice Address - Country:US
Practice Address - Phone:973-758-1151
Practice Address - Fax:973-758-1152
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYV005967152W00000X
NC1727152W00000X
FL3861152W00000X
NJ27OA00608600152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV08098Medicare UPIN