MEDICARE: DR. JAY K WASSERMAN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	35734	NY

General Provider Information

NPI Number	:	1144432410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAY K WASSERMAN DDS

Provider Business Mailing Address
First Line	:	351 BAY RD
Second Line	:
City	:	QUEENSBURY
State	:	NY
Zip	:	12804-1403
Country	:	US
Telephone Number	:	518-792-1112
Fax Number	:	518-792-1113

Provider Business Practice Location Address
First Line	:	351 BAY RD
Second Line	:
City	:	QUEENSBURY
State	:	NY
Zip	:	12804-1403
Country	:	US
Telephone Number	:	518-792-1112
Fax Number	:	518-792-1113

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	07/09/2007

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