Provider Demographics
NPI:1407940687
Name:WOLFIN, NANCY SUE (MD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:SUE
Last Name:WOLFIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 E SHORE RD
Mailing Address - Street 2:204
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-2432
Mailing Address - Country:US
Mailing Address - Phone:516-829-4464
Mailing Address - Fax:516-829-0931
Practice Address - Street 1:310 E SHORE RD
Practice Address - Street 2:204
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11023-2432
Practice Address - Country:US
Practice Address - Phone:516-829-4464
Practice Address - Fax:516-829-0931
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY153906207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY75D291Medicare ID - Type Unspecified
NYA64135Medicare UPIN