Provider Demographics
NPI:1154582484
Name:WASSERSTROM, HEATHER (MD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:
Last Name:WASSERSTROM
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 1:124 W 60TH ST
Mailing Address - Street 2:APT 11A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-7451
Mailing Address - Country:US
Mailing Address - Phone:201-280-8993
Mailing Address - Fax:
Practice Address - Street 1:124 W 60TH ST
Practice Address - Street 2:APT 11A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-7451
Practice Address - Country:US
Practice Address - Phone:201-280-8993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-19
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY273312-1208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics