Provider Demographics
NPI:1639518202
Name:WASSERLAUF, DAVID (OD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:WASSERLAUF
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9-01 SADDLE RIVER RD
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-5717
Mailing Address - Country:US
Mailing Address - Phone:347-558-3413
Mailing Address - Fax:845-352-5092
Practice Address - Street 1:40 MAIN ST
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-3009
Practice Address - Country:US
Practice Address - Phone:845-385-9500
Practice Address - Fax:845-352-5092
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-17
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00692300152W00000X
NY008002152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03915762Medicaid