Provider Demographics
NPI:1265631600
Name:WOLFF, RANAN CHAIM (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANAN
Middle Name:CHAIM
Last Name:WOLFF
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1229 BROADWAY
Mailing Address - Street 2:SUIT 204
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557
Mailing Address - Country:US
Mailing Address - Phone:516-569-5566
Mailing Address - Fax:516-569-2858
Practice Address - Street 1:1229 BROADWAY
Practice Address - Street 2:SUITE 204
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557-2014
Practice Address - Country:US
Practice Address - Phone:516-569-5566
Practice Address - Fax:516-569-2858
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0397131223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01471681Medicare PIN