Evan Guy Wasserman, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

22DI01303200 Issued in NJ

Practice address

301 Madison Ave
Lakewood, NJ 08701-3266

Phone

(732) 363-0177

Fax

(732) 363-0115

NPI assigned

Jul 19, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1679592406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 MADISON AVE",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087013266",
            "telephone_number": "732-363-0177",
            "fax_number": "732-363-0115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 MADISON AVE",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087013266",
            "telephone_number": "732-363-0177",
            "fax_number": "732-363-0115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WASSERMAN",
        "first_name": "EVAN",
        "middle_name": "GUY",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "22DI01303200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Allyson Walsh, FNP-C
• Kelly Walsh
• Erica Waltner
• Debora Warshavchik, APN
• Christine Monet Washington
• Sora Wasserman
• Esther Wax
• Rebecca Wax, MS-CCC-SLP
• Frayda Waxman
• Meir Waxman, RN

• General Practice Dentistry in Lakewood, NJ
• Providers in Lakewood, NJ by specialty
• General Practice Dentistry in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.