Provider Demographics
NPI:1558363473
Name:WOLFSON, H WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:H WILLIAM
Middle Name:
Last Name:WOLFSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:HYMAN
Other - Middle Name:WILLIAM
Other - Last Name:WOLFSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 1101
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-0942
Mailing Address - Country:US
Mailing Address - Phone:631-543-5125
Mailing Address - Fax:631-543-0090
Practice Address - Street 1:131 PARKWAY DR N
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-4908
Practice Address - Country:US
Practice Address - Phone:631-543-5125
Practice Address - Fax:631-543-0090
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX3031111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX16961Medicare PIN