Provider Demographics
NPI:1598796930
Name:WOLF, ERIC JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:JAY
Last Name:WOLF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8A FRANKLIN PL
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-1211
Mailing Address - Country:US
Mailing Address - Phone:516-570-6186
Mailing Address - Fax:
Practice Address - Street 1:1180 MORRIS PARK AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1925
Practice Address - Country:US
Practice Address - Phone:718-892-6110
Practice Address - Fax:718-892-6111
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229282207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI56681Medicare UPIN
NY540A01Medicare ID - Type Unspecified