Provider Demographics
NPI:1598027351
Name:WASSERMAN, MICHAEL LEE (MSED)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LEE
Last Name:WASSERMAN
Suffix:
Gender:M
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2461 E 29TH ST
Mailing Address - Street 2:APT 2E
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-1951
Mailing Address - Country:US
Mailing Address - Phone:718-648-7173
Mailing Address - Fax:
Practice Address - Street 1:2461 E 29TH ST
Practice Address - Street 2:APT 2E
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-1951
Practice Address - Country:US
Practice Address - Phone:718-648-7173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1852276174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist