Provider Demographics
NPI:1881759330
Name:WASSERMANN, EVELYN R (MD)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:R
Last Name:WASSERMANN
Suffix:
Gender:F
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:PO BOX 797
Mailing Address - Street 2:16 KENDALL DRIVE
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956
Mailing Address - Country:US
Mailing Address - Phone:845-557-0300
Mailing Address - Fax:845-557-0300
Practice Address - Street 1:255 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901
Practice Address - Country:US
Practice Address - Phone:845-368-5199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1442272084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
611BD1OtherEMPIRE BLUE CROSS AND BLU
NY01348172Medicaid
NY01348172Medicaid
NY20E13FW351Medicare PIN