Provider Demographics
NPI:1164460952
Name:WOLF, JEFFREY M (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:M
Last Name:WOLF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:233 E SHORE RD
Mailing Address - Street 2:#112
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-2433
Mailing Address - Country:US
Mailing Address - Phone:516-482-7810
Mailing Address - Fax:516-482-3760
Practice Address - Street 1:233 E SHORE RD
Practice Address - Street 2:#112
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11023-2433
Practice Address - Country:US
Practice Address - Phone:516-482-7810
Practice Address - Fax:516-482-3760
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY201158207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02082240Medicaid
NY02082240Medicaid
NYH12789Medicare UPIN