Provider Demographics
NPI:1710946827
Name:WOLGEL, CLAUDE D (MD)
Entity Type:Individual
Prefix:
First Name:CLAUDE
Middle Name:D
Last Name:WOLGEL
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 1:111-15 QUEENS BLVD.
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375
Mailing Address - Country:US
Mailing Address - Phone:718-263-8188
Mailing Address - Fax:718-897-9104
Practice Address - Street 1:111-15 QUEENS BLVD.
Practice Address - Street 2:2ND FLOOR
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:718-263-8188
Practice Address - Fax:718-897-9104
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY135093174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00739419Medicaid
NY00739419Medicaid
NY08199LMedicare PIN