Provider Demographics
NPI:1255345625
Name:WASSERMAN, SHELDON MARC (MD)
Entity type:Individual
Prefix:
First Name:SHELDON
Middle Name:MARC
Last Name:WASSERMAN
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 1:421 HUGUENOT STREET
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-7004
Mailing Address - Country:US
Mailing Address - Phone:914-636-4418
Mailing Address - Fax:914-636-2975
Practice Address - Street 1:421 HUGUENOT STREET
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-7004
Practice Address - Country:US
Practice Address - Phone:914-636-4418
Practice Address - Fax:914-636-2975
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1289212084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00579882Medicaid
B80511Medicare UPIN
NY00579882Medicaid