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General NPI Number Information
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NPI Number | 1093079899
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Entity Type | Individual
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Provider Name | ALEX O VASSERMAN DMD
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Gender | Male
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Dates
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Enumeration Date | 06/27/2012
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Last Update Date | 03/04/2016
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Provider Practice Location Address
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Address Line | 349 E 52ND ST APT 1
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City | NEW YORK
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State | NY
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Zip | 10022-6320
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Country | US
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Telephone | 212-882-1102
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Fax |
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Provider Business Mailing Address
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Address Line | 1 COLUMBUS PL APT N9K
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City | NEW YORK
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State | NY
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Zip | 10019-8221
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Country | US
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Telephone | 781-492-5898
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 10750
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License Number State | CT
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