Provider Demographics
NPI:1790957843
Name:DAVID J WOLF M.D., PC
Entity Type:Organization
Organization Name:DAVID J WOLF M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:ALLA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-688-7100
Mailing Address - Street 1:115 E 61ST ST
Mailing Address - Street 2:11TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-8183
Mailing Address - Country:US
Mailing Address - Phone:212-688-7100
Mailing Address - Fax:212-308-5242
Practice Address - Street 1:115 E 61ST ST
Practice Address - Street 2:11TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-8183
Practice Address - Country:US
Practice Address - Phone:212-688-7100
Practice Address - Fax:212-308-5242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-28
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY121007174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0719220972OtherRR MEDICARE
NY0719220972OtherRR MEDICARE
NY06A321Medicare PIN
NYA100000361Medicare PIN