MEDICARE: RANDI S WASSERMAN

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	2080N0001X	Neonatal-Perinatal Medicine Physician	143376	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851388771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDI S WASSERMAN

Provider Business Mailing Address
First Line	:	7901 BROADWAY
Second Line	:	A734
City	:	ELMHURST
State	:	NY
Zip	:	11373-1329
Country	:	US
Telephone Number	:	718-334-3380
Fax Number	:

Provider Business Practice Location Address
First Line	:	7901 BROADWAY
Second Line	:	A734
City	:	ELMHURST
State	:	NY
Zip	:	11373-1329
Country	:	US
Telephone Number	:	718-334-3380
Fax Number	:

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

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	08/20/2015

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Directions to “ RANDI S WASSERMAN ” Practice Location

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