Provider Demographics
NPI:1699037457
Name:WOLFSON, BENJAMIN (MED)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:
Last Name:WOLFSON
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1484 E 32ND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-3404
Mailing Address - Country:US
Mailing Address - Phone:718-513-1436
Mailing Address - Fax:
Practice Address - Street 1:1484 E 32ND ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-3404
Practice Address - Country:US
Practice Address - Phone:718-513-1436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist