Provider Demographics
NPI:1154394906
Name:WASSNER, JESSE V (MD)
Entity type:Individual
Prefix:DR
First Name:JESSE
Middle Name:V
Last Name:WASSNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5525 RESEARCH PARK DRIVE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4664
Mailing Address - Country:US
Mailing Address - Phone:973-831-3540
Mailing Address - Fax:973-831-3503
Practice Address - Street 1:1 CEDAR CREST DR
Practice Address - Street 2:
Practice Address - City:POMPTON PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07444-2100
Practice Address - Country:US
Practice Address - Phone:973-831-3540
Practice Address - Fax:973-831-3503
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ52233207R00000X
NJ25MA05223300207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
04-74836OtherEVERCARE
NJ7022905Medicaid
522114204001OtherTRICARE
NJ7726805Medicaid
E61142Medicare UPIN
635264XNMMedicare PIN
P00734883Medicare PIN
NJ635264MDJMedicare PIN