Provider Demographics
NPI:1528210945
Name:WOFSEY, EDEN W (DMD)
Entity Type:Individual
Prefix:
First Name:EDEN
Middle Name:W
Last Name:WOFSEY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CENTRAL PARK S
Mailing Address - Street 2:SUITE 211
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1436
Mailing Address - Country:US
Mailing Address - Phone:212-307-1703
Mailing Address - Fax:212-307-1540
Practice Address - Street 1:200 CENTRAL PARK S
Practice Address - Street 2:SUITE 211
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1436
Practice Address - Country:US
Practice Address - Phone:212-307-1703
Practice Address - Fax:212-307-1540
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04244911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice