Provider Demographics
NPI:1013001593
Name:WOLK, SUSAN ILENE (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ILENE
Last Name:WOLK
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Gender:F
Credentials:MD
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Mailing Address - Street 1:275 CENTRAL PARK W
Mailing Address - Street 2:SUITE 1F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3015
Mailing Address - Country:US
Mailing Address - Phone:212-874-6579
Mailing Address - Fax:212-874-6579
Practice Address - Street 1:275 CENTRAL PARK W
Practice Address - Street 2:SUITE 1F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3015
Practice Address - Country:US
Practice Address - Phone:212-874-6579
Practice Address - Fax:212-874-6579
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NY1832042084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY61H261Medicare UPIN