Provider Demographics
NPI:1740394691
Name:WASSERMAN, HOWARD JAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:JAY
Last Name:WASSERMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 W 54TH ST
Mailing Address - Street 2:SUITE 1E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-5404
Mailing Address - Country:US
Mailing Address - Phone:212-265-7150
Mailing Address - Fax:212-977-9486
Practice Address - Street 1:45 W 54TH ST
Practice Address - Street 2:SUITE 1E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-5404
Practice Address - Country:US
Practice Address - Phone:212-265-7150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0365961223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics