Provider Demographics
NPI:1174516181
Name:WASSERMAN, STEVEN JAY (MD PL)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:JAY
Last Name:WASSERMAN
Suffix:
Gender:M
Credentials:MD PL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 AVENIDA DEL CIRCO
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-4108
Mailing Address - Country:US
Mailing Address - Phone:941-484-8222
Mailing Address - Fax:941-486-0316
Practice Address - Street 1:1111 AVENIDA DEL CIRCO
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-4108
Practice Address - Country:US
Practice Address - Phone:941-484-8222
Practice Address - Fax:941-486-0316
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME36514207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD86089Medicare UPIN
FL58313Medicare PIN