Provider Demographics
NPI:1407875966
Name:WOLFF, CHARLES J (DPM)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:J
Last Name:WOLFF
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CROSFIELD AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-2226
Mailing Address - Country:US
Mailing Address - Phone:845-358-2844
Mailing Address - Fax:845-358-0528
Practice Address - Street 1:2 CROSFIELD AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-2226
Practice Address - Country:US
Practice Address - Phone:845-358-2844
Practice Address - Fax:845-358-0528
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004857213ES0103X
NJ2058213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1057830001Medicare NSC
NYP53121Medicare ID - Type Unspecified
NYU20186Medicare UPIN
P53121Medicare PIN
NJ035233UTVMedicare PIN