Provider Demographics
NPI:1992826713
Name:DR. JOHN W. WOLF DDS, PC
Entity Type:Organization
Organization Name:DR. JOHN W. WOLF DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-366-5900
Mailing Address - Street 1:212 W 15TH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-6501
Mailing Address - Country:US
Mailing Address - Phone:212-366-5900
Mailing Address - Fax:212-366-6028
Practice Address - Street 1:212 W 15TH ST FL 1
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-6501
Practice Address - Country:US
Practice Address - Phone:212-366-5900
Practice Address - Fax:212-366-6028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038642305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service