Healthcare Provider Details

I. General information

NPI: 1023066198
Provider Name (Legal Business Name): MELISSA PITTEL WASSERSTEIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 04/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GUSTAVE L LEVY PL BOX 1497
NEW YORK NY
10029-6500
US

IV. Provider business mailing address

79 FERDON AVE
SPARKILL NY
10976-1301
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-2478
  • Fax:
Mailing address:
  • Phone: 845-365-9767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number194048
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207SG0202X
TaxonomyClinical Biochemical Genetics Physician
License Number194048
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: