Provider Demographics
NPI:1407931868
Name:WOLLOCH, NORBERT S (MD)
Entity Type:Individual
Prefix:
First Name:NORBERT
Middle Name:S
Last Name:WOLLOCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 CENTRAL PARK AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-1044
Mailing Address - Country:US
Mailing Address - Phone:914-964-4000
Mailing Address - Fax:914-964-4050
Practice Address - Street 1:MMG - CROSS COUNTY
Practice Address - Street 2:1010 CENTRAL PARK AVENUE
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704
Practice Address - Country:US
Practice Address - Phone:914-964-4000
Practice Address - Fax:914-964-4050
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY151532208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics