Provider Demographics
NPI:1518049832
Name:WASSERMAN, GARY D (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:D
Last Name:WASSERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DIAMOND HILL RD
Mailing Address - Street 2:
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-2104
Mailing Address - Country:US
Mailing Address - Phone:908-273-4300
Mailing Address - Fax:
Practice Address - Street 1:663 PALISADE AVE STE 304
Practice Address - Street 2:
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010-3012
Practice Address - Country:US
Practice Address - Phone:201-313-1933
Practice Address - Fax:201-313-9599
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05621000208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4S9831OtherEMPIRE BCBS# (75 SOUTH DEAN)
NJ4S9833OtherEMPIRE BCBS# (180 N. DEAN)
NJ4S9832OtherEMPIRE BCBS# (CLIFFSIDE PARK)
NJ80988OtherAMERIGROUP#
NJ4562801Medicaid
NJBS350OtherOXFORD#
NJP00392865OtherRAILROAD MEDICARE#
NJ4562801Medicaid