Provider Demographics
NPI:1043574833
Name:WOLFF, JAMEY
Entity Type:Individual
Prefix:
First Name:JAMEY
Middle Name:
Last Name:WOLFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 KUKUK LN
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-6943
Mailing Address - Country:US
Mailing Address - Phone:845-336-2616
Mailing Address - Fax:
Practice Address - Street 1:70 KUKUK LN
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-6943
Practice Address - Country:US
Practice Address - Phone:845-336-2616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY508346041174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist