Provider Demographics
NPI:1538250204
Name:WASSERSTEIN, ADELLA (MD)
Entity type:Individual
Prefix:
First Name:ADELLA
Middle Name:
Last Name:WASSERSTEIN
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 1:3011 KERSDALE RD
Mailing Address - Street 2:
Mailing Address - City:PEPPER PIKE
Mailing Address - State:OH
Mailing Address - Zip Code:44124-5349
Mailing Address - Country:US
Mailing Address - Phone:917-304-7192
Mailing Address - Fax:
Practice Address - Street 1:3011 KERSDALE RD
Practice Address - Street 2:
Practice Address - City:PEPPER PIKE
Practice Address - State:OH
Practice Address - Zip Code:44124-5349
Practice Address - Country:US
Practice Address - Phone:212-721-3462
Practice Address - Fax:206-666-1992
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1889462084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0320367Medicaid