Healthcare Provider Details

I. General information

NPI: 1376085860
Provider Name (Legal Business Name): NOA ZEMER WASSERCUG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2016
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 W 168TH ST
NEW YORK NY
10032-3729
US

IV. Provider business mailing address

630 W 168TH ST # 4
NEW YORK NY
10032-3725
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-6936
  • Fax: 212-305-0490
Mailing address:
  • Phone: 212-305-6936
  • Fax: 212-305-0490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number291576
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RA0002X
TaxonomyAdult Congenital Heart Disease Physician
License Number291576
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: