Provider Demographics
NPI:1962636019
Name:WASSER, GERI LYNN (RD,MA,CDE)
Entity Type:Individual
Prefix:
First Name:GERI
Middle Name:LYNN
Last Name:WASSER
Suffix:
Gender:F
Credentials:RD,MA,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 VASSAR ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-6004
Mailing Address - Country:US
Mailing Address - Phone:718-761-1651
Mailing Address - Fax:
Practice Address - Street 1:58 VASSAR ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-6004
Practice Address - Country:US
Practice Address - Phone:718-761-1651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-04
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY441837133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered