Provider Demographics
NPI:1437490463
Name:WASSERMAN, ELEN (DO)
Entity type:Individual
Prefix:DR
First Name:ELEN
Middle Name:
Last Name:WASSERMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 RAYMOND AVE
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-1132
Mailing Address - Country:US
Mailing Address - Phone:646-752-5734
Mailing Address - Fax:
Practice Address - Street 1:556 PASSAIC AVE
Practice Address - Street 2:
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-7449
Practice Address - Country:US
Practice Address - Phone:973-808-2273
Practice Address - Fax:973-808-2267
Is Sole Proprietor?:No
Enumeration Date:2013-03-15
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB09807100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine