Provider Demographics
NPI:1922099852
Name:WASSER, STUART (MD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:
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 1:176 N. VILLAGE AVENUE
Mailing Address - Street 2:SUITE 2E
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570
Mailing Address - Country:US
Mailing Address - Phone:516-594-2514
Mailing Address - Fax:516-208-5510
Practice Address - Street 1:176 N. VILLAGE AVENUE
Practice Address - Street 2:SUITE 2E
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570
Practice Address - Country:US
Practice Address - Phone:516-594-2514
Practice Address - Fax:516-208-5510
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY173354207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01624193Medicaid
D92207Medicare UPIN
NY01624193Medicaid
092207Medicare UPIN
17F802Medicare PIN
17F801Medicare PIN