Provider Demographics
NPI:1659378248
Name:WASSERMAN, BARRY N (MD)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:N
Last Name:WASSERMAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FEDERAL ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1088
Mailing Address - Country:US
Mailing Address - Phone:848-288-6935
Mailing Address - Fax:732-790-0107
Practice Address - Street 1:3 COOPER PLZ RM 200
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1438
Practice Address - Country:US
Practice Address - Phone:856-342-2001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD062901L207W00000X
NJ25MA06022300207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8170801Medicaid
NJ0399372000OtherINDEPENDENCE B/C
NJ5791562OtherAETNA
NJ2300970OtherAETNA HMO
NJ407203OtherAMERIHEALTH
NJ1117826OtherHORIZON NJ HEALTH
NJ2K1973OtherHEALTH NET
NJ2300970OtherAETNA HMO
NJ8170801Medicaid
NJ407203OtherAMERIHEALTH