Provider Demographics
NPI:1194755686
Name:WASSERSTROM, WILLIAM R (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:R
Last Name:WASSERSTROM
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:F-1 BRIER HILL COURT
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816
Mailing Address - Country:US
Mailing Address - Phone:732-238-0804
Mailing Address - Fax:732-651-8790
Practice Address - Street 1:F-1 BRIER HILL COURT
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816
Practice Address - Country:US
Practice Address - Phone:732-238-0804
Practice Address - Fax:732-651-8790
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA422132084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ059860701Medicaid
A44237Medicare UPIN
NJ469268Medicare ID - Type Unspecified