Provider Demographics
NPI:1962458836
Name:BARRY N. WASSERMAN, MD LLC
Entity Type:Organization
Organization Name:BARRY N. WASSERMAN, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:N
Authorized Official - Last Name:WASSERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-243-8711
Mailing Address - Street 1:100 CANAL POINTE BLVD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-7063
Mailing Address - Country:US
Mailing Address - Phone:609-243-8711
Mailing Address - Fax:
Practice Address - Street 1:100 CANAL POINTE BLVD
Practice Address - Street 2:SUITE 112
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-7063
Practice Address - Country:US
Practice Address - Phone:609-243-8711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06022300207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8170801Medicaid
PA01652265Medicaid
NJ8170801Medicaid
PA01652265Medicaid
077994Medicare PIN