Provider Demographics
NPI:1114950797
Name:WULFSOHN, MENDLEY A (MD)
Entity Type:Individual
Prefix:DR
First Name:MENDLEY
Middle Name:A
Last Name:WULFSOHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 CLIFTON AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013
Mailing Address - Country:US
Mailing Address - Phone:973-473-5700
Mailing Address - Fax:973-473-3367
Practice Address - Street 1:1033 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3517
Practice Address - Country:US
Practice Address - Phone:973-473-5700
Practice Address - Fax:973-473-3367
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA37283208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0110272000OtherAMERIHEALTH ID#
NJ04A761OtherEMPIRE BCBS (CLIFTON)
NJ04A762OtherEMPIRE BCBS (WAYNE)
NJPS124OtherOXFORD ID#
NJ0028399OtherAETNA HMO#
NJ1000339OtherGHI PPO#
NJ0K2315OtherHEALTHNET ID#
NJ398357OtherWELLCARE
NJ4229231OtherAETNA PPO#
NJ1000339OtherGHI PPO#
NJ0110272000OtherAMERIHEALTH ID#