Provider Demographics
NPI:1235375817
Name:BARRY G. WOLFF, DPM
Entity Type:Organization
Organization Name:BARRY G. WOLFF, DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LANA
Authorized Official - Middle Name:K
Authorized Official - Last Name:DILIBERTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-627-3737
Mailing Address - Street 1:777 BLACKWOOD CLEMENTON RD
Mailing Address - Street 2:
Mailing Address - City:LINDENWOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-5966
Mailing Address - Country:US
Mailing Address - Phone:856-627-3737
Mailing Address - Fax:856-435-5596
Practice Address - Street 1:777 BLACKWOOD CLEMENTON RD
Practice Address - Street 2:
Practice Address - City:LINDENWOLD
Practice Address - State:NJ
Practice Address - Zip Code:08021-5966
Practice Address - Country:US
Practice Address - Phone:856-627-3737
Practice Address - Fax:856-435-5596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-02
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00091300335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0598580001Medicare NSC