Provider Demographics
NPI:1093785537
Name:WOLF, DEBRA A (PA)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:A
Last Name:WOLF
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1001 W FAYETTE ST
Mailing Address - Street 2:STE 400
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-2859
Mailing Address - Country:US
Mailing Address - Phone:315-472-1488
Mailing Address - Fax:315-472-8060
Practice Address - Street 1:4828 W TAFT RD
Practice Address - Street 2:SUITE 215
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-4810
Practice Address - Country:US
Practice Address - Phone:315-413-0004
Practice Address - Fax:315-413-0828
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2008-05-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY002450363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPA1141Medicare PIN
NYP53157Medicare UPIN
NYP00385027Medicare PIN