Provider Demographics
NPI:1093470502
Name:WOLFF, JACLYN ROSS
Entity Type:Individual
Prefix:MS
First Name:JACLYN
Middle Name:ROSS
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 1:590 AVENUE OF THE AMERICAS
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-2022
Mailing Address - Country:US
Mailing Address - Phone:212-633-3000
Mailing Address - Fax:
Practice Address - Street 1:170 BROWN PL
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10454-4140
Practice Address - Country:US
Practice Address - Phone:347-930-9784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program