Provider Demographics
NPI:1033878541
Name:WOLFE, VICENTE
Entity Type:Individual
Prefix:
First Name:VICENTE
Middle Name:
Last Name:WOLFE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 FAIRFIELD RD APT 1
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07004-2401
Mailing Address - Country:US
Mailing Address - Phone:973-914-5050
Mailing Address - Fax:
Practice Address - Street 1:88 FAIRFIELD RD APT 1
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07004-2401
Practice Address - Country:US
Practice Address - Phone:973-914-5050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-12
Last Update Date:2021-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist