Provider Demographics
NPI:1427367275
Name:WASSERMAN, JUDITH G (OTR/L)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:G
Last Name:WASSERMAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W END AVE
Mailing Address - Street 2:23A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-4801
Mailing Address - Country:US
Mailing Address - Phone:914-924-2366
Mailing Address - Fax:
Practice Address - Street 1:200 W END AVE
Practice Address - Street 2:23A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-4801
Practice Address - Country:US
Practice Address - Phone:914-924-2366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001838-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY001838-1 7000502OtherNY STATE DEPT OF EDUCATION