Provider Demographics
NPI:1639227069
Name:WOLFSON, JOEL IRWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:IRWIN
Last Name:WOLFSON
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 1:38 BON AIR AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10804-3205
Mailing Address - Country:US
Mailing Address - Phone:914-654-8764
Mailing Address - Fax:914-654-2989
Practice Address - Street 1:38 BON AIR AVE
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10804-3205
Practice Address - Country:US
Practice Address - Phone:914-654-8764
Practice Address - Fax:914-654-2989
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1597292084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY080630OtherVALUE OPTIONS
NY3101428OtherGRI
66F842Medicare ID - Type Unspecified
B74823Medicare UPIN