Provider Demographics
NPI:1013997378
Name:WASSEF, NADER (MD)
Entity Type:Individual
Prefix:DR
First Name:NADER
Middle Name:
Last Name:WASSEF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-1355
Mailing Address - Country:US
Mailing Address - Phone:518-561-2700
Mailing Address - Fax:518-561-0179
Practice Address - Street 1:14 HEALEY AVE
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2421
Practice Address - Country:US
Practice Address - Phone:518-561-1603
Practice Address - Fax:518-561-0179
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY129310-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00562827Medicaid
NY51136BMedicare ID - Type Unspecified
B83024Medicare UPIN