Provider Demographics
NPI:1477686400
Name:WOLKENBERG, ANDREA (PT, MA)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:
Last Name:WOLKENBERG
Suffix:
Gender:F
Credentials:PT, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:853 7TH AVE
Mailing Address - Street 2:APT. 12C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-5215
Mailing Address - Country:US
Mailing Address - Phone:917-656-2669
Mailing Address - Fax:
Practice Address - Street 1:244 WESTCHESTER AVE
Practice Address - Street 2:SUITE 312
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10604-2907
Practice Address - Country:US
Practice Address - Phone:914-948-7400
Practice Address - Fax:914-948-5171
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
070911Medicare ID - Type Unspecified