Healthcare Provider Details

I. General information

NPI: 1013997378
Provider Name (Legal Business Name): NADER WASSEF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 HEALEY AVE
PLATTSBURGH NY
12901-2421
US

IV. Provider business mailing address

132 PROSPECT AVE
PLATTSBURGH NY
12901-1355
US

V. Phone/Fax

Practice location:
  • Phone: 518-561-1603
  • Fax: 518-561-0179
Mailing address:
  • Phone: 518-561-2700
  • Fax: 518-561-0179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number129310-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: