Provider Demographics
NPI:1417422536
Name:WOLF, ALLISON (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ALLISON
Middle Name:
Last Name:WOLF
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 FAWN DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NJ
Mailing Address - Zip Code:08833-3019
Mailing Address - Country:US
Mailing Address - Phone:908-328-1131
Mailing Address - Fax:
Practice Address - Street 1:1133 YORK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-8307
Practice Address - Country:US
Practice Address - Phone:646-888-7089
Practice Address - Fax:929-321-7023
Is Sole Proprietor?:No
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022260363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant