Provider Demographics
NPI:1023154069
Name:WASSERMAN, DANIEL HORACIO
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:HORACIO
Last Name:WASSERMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11203 QUEENS BLVD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-5550
Mailing Address - Country:US
Mailing Address - Phone:718-544-7077
Mailing Address - Fax:718-261-4476
Practice Address - Street 1:11203 QUEENS BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-5550
Practice Address - Country:US
Practice Address - Phone:718-544-7077
Practice Address - Fax:718-261-4476
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY170615-1207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01078399Medicaid
NYE4114Medicare UPIN
NY01078399Medicaid