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NPI Code Detail

MEDICARE: DR. JESSE V WASSNER MD

MEDICARE: DR. JESSE V WASSNER MD
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
1207R00000XInternal Medicine Physician52233NJ
2207RG0300XGeriatric Medicine (Internal Medicine) Physician25MA05223300NJ
3207R00000XInternal Medicine Physician303059NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
104-74836OTHEREVERCARE
2522114204001OTHERTRICARE
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1154394906
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JESSE V WASSNER MD
Provider Business Mailing Address
First Line : PO BOX 746087
Second Line :
City : ATLANTA
State : GA
Zip : 30374-6087
Country : US
Telephone Number : 312-733-9730
Fax Number :
Provider Business Practice Location Address
First Line : 2721 BRONXWOOD AVE
Second Line :
City : BRONX
State : NY
Zip : 10469-3642
Country : US
Telephone Number : 718-765-6350
Fax Number : 347-736-0207
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/10/2006
Last Update Date : 05/19/2025

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Directions to “ DR. JESSE V WASSNER MD” Practice Location

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