Provider Demographics
NPI:1629152236
Name:WOLF, MARLIN CHRISTIAN JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARLIN
Middle Name:CHRISTIAN
Last Name:WOLF
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:M.
Other - Middle Name:CHRIS
Other - Last Name:WOLF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:13750 SOUTHWEST 32ND STREET
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-3984
Mailing Address - Country:US
Mailing Address - Phone:609-744-8387
Mailing Address - Fax:
Practice Address - Street 1:13750 SOUTHWEST 32ND STREET
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-3984
Practice Address - Country:US
Practice Address - Phone:609-744-8387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00260700103G00000X
PAPS005218L103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5332401Medicaid
NJ186649Medicare PIN
NJ5332401Medicaid
NJ5332401Medicaid