Provider Demographics
NPI:1124120555
Name:WASSER, DAVID MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MICHAEL
Last Name:WASSER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 W BROADWAY
Mailing Address - Street 2:STE 34
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557
Mailing Address - Country:US
Mailing Address - Phone:516-374-9800
Mailing Address - Fax:516-374-9805
Practice Address - Street 1:1175 W BROADWAY
Practice Address - Street 2:STE 34
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557
Practice Address - Country:US
Practice Address - Phone:516-374-9800
Practice Address - Fax:516-374-9805
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY136983207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07A971Medicare ID - Type Unspecified
C05177Medicare UPIN