Provider Demographics
NPI:1164666244
Name:WOLFF, MARTIN JACOB (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:JACOB
Last Name:WOLFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:535 5TH AVE RM 604
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-8010
Mailing Address - Country:US
Mailing Address - Phone:212-794-0240
Mailing Address - Fax:212-227-3368
Practice Address - Street 1:535 5TH AVE RM 604
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-8010
Practice Address - Country:US
Practice Address - Phone:212-794-0240
Practice Address - Fax:212-922-2188
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2020-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY257517207RG0100X, 207RG0100X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology