Provider Demographics
NPI:1154394906
Name:WASSNER, JESSE V (MD)
Entity type:Individual
Prefix:DR
First Name:JESSE
Middle Name:V
Last Name:WASSNER
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:PO BOX 746087
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6087
Mailing Address - Country:US
Mailing Address - Phone:312-733-9730
Mailing Address - Fax:
Practice Address - Street 1:2721 BRONXWOOD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-3642
Practice Address - Country:US
Practice Address - Phone:718-765-6350
Practice Address - Fax:347-736-0207
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ52233207R00000X
NJ25MA05223300207RG0300X
NY303059207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
04-74836OtherEVERCARE
522114204001OtherTRICARE
NJ7022905Medicaid
NJ7726805Medicaid
E61142Medicare UPIN
635264XNMMedicare PIN
P00734883Medicare PIN
NJ635264MDJMedicare PIN