Provider Demographics
NPI:1215055231
Name:TISCORNIA-WASSERMAN, PATRICIA G (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:G
Last Name:TISCORNIA-WASSERMAN
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 1:630 WEST 168TH ST PH 1564W
Mailing Address - Street 2:
Mailing Address - City:NY
Mailing Address - State:NY
Mailing Address - Zip Code:10032
Mailing Address - Country:US
Mailing Address - Phone:718-470-7592
Mailing Address - Fax:718-347-4866
Practice Address - Street 1:630 WEST 168TH ST PH 1564W
Practice Address - Street 2:
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:10032
Practice Address - Country:US
Practice Address - Phone:212-305-7399
Practice Address - Fax:718-347-4866
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175830207ZC0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY78F42Medicare ID - Type Unspecified
NYE74791Medicare UPIN