Provider Demographics
NPI:1891765582
Name:WASSER, WALTER GABRIEL (MD)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:GABRIEL
Last Name:WASSER
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 1:211 WEST 61ST ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023
Mailing Address - Country:US
Mailing Address - Phone:212-977-3100
Mailing Address - Fax:212-977-3475
Practice Address - Street 1:211 WEST 61ST ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023
Practice Address - Country:US
Practice Address - Phone:212-977-3100
Practice Address - Fax:212-977-3475
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1332561207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NS635OtherOXFORD
NY00837081Medicaid
0090217OtherAETNA
NY09D571Medicare PIN
NY00837081Medicaid