Provider Demographics
NPI:1457373821
Name:WASSMER, TODD B (DC)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:B
Last Name:WASSMER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GARRET MOUNTAIN PLZ
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-3320
Mailing Address - Country:US
Mailing Address - Phone:973-771-0873
Mailing Address - Fax:
Practice Address - Street 1:1 GARRET MOUNTAIN PLZ
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07424-3320
Practice Address - Country:US
Practice Address - Phone:973-771-0873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246ZE0600X
FLCH9223111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU8103ZMedicare ID - Type Unspecified