Provider Demographics
NPI:1790133874
Name:WOLFE, ALIZA ROSENBLUM
Entity Type:Individual
Prefix:MS
First Name:ALIZA
Middle Name:ROSENBLUM
Last Name:WOLFE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 BLEECKER ST
Mailing Address - Street 2:APT 3J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-1544
Mailing Address - Country:US
Mailing Address - Phone:617-721-5109
Mailing Address - Fax:
Practice Address - Street 1:88 BLEECKER ST
Practice Address - Street 2:APT 3J
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-1544
Practice Address - Country:US
Practice Address - Phone:617-721-5109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-30
Last Update Date:2016-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY639959-1367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY639959-1OtherTHE UNIVERSITY OF THE STATE OF NEW YORK - EDUCATION DEPARTMENT