Basic Information
| Provider Information | |||||||||
| NPI: | 1013997378 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WASSEF | ||||||||
| FirstName: | NADER | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 132 PROSPECT AVE | ||||||||
| Address2: | |||||||||
| City: | PLATTSBURGH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 129011355 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5185612700 | ||||||||
| FaxNumber: | 5185610179 | ||||||||
| Practice Location | |||||||||
| Address1: | 14 HEALEY AVE | ||||||||
| Address2: | |||||||||
| City: | PLATTSBURGH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 129012421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5185611603 | ||||||||
| FaxNumber: | 5185610179 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 129310-1 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00562827 | 05 | NY | MEDICAID |