Provider Demographics
NPI:1437537800
Name:WOLF, VERLENE
Entity Type:Individual
Prefix:MRS
First Name:VERLENE
Middle Name:
Last Name:WOLF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 EVERGREEN PL
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-2005
Mailing Address - Country:US
Mailing Address - Phone:862-930-3819
Mailing Address - Fax:888-748-5787
Practice Address - Street 1:137 EVERGREEN PL
Practice Address - Street 2:SUITE 2C
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-2005
Practice Address - Country:US
Practice Address - Phone:862-930-3819
Practice Address - Fax:888-748-5787
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-18
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NE01218900164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0473880Medicaid