Provider Demographics
NPI:1295925998
Name:WASSERMAN, BRADLEY ROSS (MD)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:ROSS
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 1:1841 BROADWAY
Mailing Address - Street 2:SUITE 500
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-7603
Mailing Address - Country:US
Mailing Address - Phone:212-767-1100
Mailing Address - Fax:
Practice Address - Street 1:1841 BROADWAY
Practice Address - Street 2:SUITE 500
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-7603
Practice Address - Country:US
Practice Address - Phone:212-767-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY246054207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine