Healthcare Provider Details

I. General information

NPI: 1457373821
Provider Name (Legal Business Name): TODD B WASSMER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 01/14/2020
Certification Date: 01/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GARRET MOUNTAIN PLZ
WOODLAND PARK NJ
07424-3320
US

IV. Provider business mailing address

1 GARRET MOUNTAIN PLZ
WOODLAND PARK NJ
07424-3320
US

V. Phone/Fax

Practice location:
  • Phone: 973-771-0873
  • Fax:
Mailing address:
  • Phone: 973-771-0873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH9223
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: