Provider Demographics
NPI:1336309673
Name:WOLFMAN, BRIAN (MD, MSC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:WOLFMAN
Suffix:
Gender:M
Credentials:MD, MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 JACK MARTIN BLVD
Mailing Address - Street 2:300
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-7737
Mailing Address - Country:US
Mailing Address - Phone:732-840-0067
Mailing Address - Fax:
Practice Address - Street 1:525 JACK MARTIN BLVD
Practice Address - Street 2:300
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-7737
Practice Address - Country:US
Practice Address - Phone:732-840-0067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-10
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY244773207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine