Provider Demographics
NPI:1568898641
Name:JEFFREY P. WASSERSTROM MD PA
Entity Type:Organization
Organization Name:JEFFREY P. WASSERSTROM MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:P
Authorized Official - Last Name:WASSERSTORM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-466-1457
Mailing Address - Street 1:3998 INLAND EMPIRE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-5032
Mailing Address - Country:US
Mailing Address - Phone:909-466-1457
Mailing Address - Fax:
Practice Address - Street 1:2000 PALM BEACK LAKES BLVD.
Practice Address - Street 2:SUITE 800
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409
Practice Address - Country:US
Practice Address - Phone:561-965-9110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery