Provider Demographics
NPI:1447562913
Name:WASSERMAN, GHIN KHENG TOH (COTA)
Entity Type:Individual
Prefix:
First Name:GHIN KHENG
Middle Name:TOH
Last Name:WASSERMAN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-2803
Mailing Address - Country:US
Mailing Address - Phone:845-278-2357
Mailing Address - Fax:
Practice Address - Street 1:88 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-2803
Practice Address - Country:US
Practice Address - Phone:845-278-2357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004862-1171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYGH28INMedicaid