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Contact Information

MARK D WASSERMAN, MD
555 ROUTE 25A
MILLER PLACE, NY11764-2625
 Phone: 631-744-6666
 Fax: 631-744-0525
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Family Medicine

207Q00000X 08 Physician/Family Practice
Indicates primary specialty

NPI Profile & details for MARK D WASSERMAN · (Male)

NPI Number 1033176805
Status Active
Credentials MD
Entity Individual
Enumeration date 04/27/2006
Last updated 02/28/2008 - About 18 years ago
Sole proprietor 1 No
Identifiers
  • NY License # 132521
  • NY Medicaid 00651661
Hospital affiliation(s)
  • JOHN T MATHER MEMORIAL HOSPITAL OF PORT JEFFERSON - (Acute Care)
    75 NORTH COUNTRY ROAD
    PORT JEFFERSON, NY 11777
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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