Provider Demographics
NPI:1518142686
Name:WASSERMAN, NOAH (DPT)
Entity Type:Individual
Prefix:
First Name:NOAH
Middle Name:
Last Name:WASSERMAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 S VAN BRUNT ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4604
Mailing Address - Country:US
Mailing Address - Phone:201-569-2770
Mailing Address - Fax:201-569-1774
Practice Address - Street 1:401 S VAN BRUNT ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4604
Practice Address - Country:US
Practice Address - Phone:201-569-2770
Practice Address - Fax:201-569-1774
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01167700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ40QA0116700OtherPT LICENSE
NJ121860PF5Medicare PIN