Provider Demographics
NPI:1760410799
Name:WOLFF, STEVEN DANA (MDPHD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:DANA
Last Name:WOLFF
Suffix:
Gender:M
Credentials:MDPHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 E 77TH ST
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-1912
Mailing Address - Country:US
Mailing Address - Phone:212-369-9200
Mailing Address - Fax:212-369-5408
Practice Address - Street 1:170 EAST 77TH STREET
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-1912
Practice Address - Country:US
Practice Address - Phone:212-369-9200
Practice Address - Fax:212-369-5408
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20963812085R0202X
NY209638-12085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02140458Medicaid
NY02140458Medicaid
NYG89231Medicare UPIN
NY61870JW601Medicare PIN