Provider Demographics
NPI:1023117132
Name:WOLKSTEIN, MURRAY A (MD)
Entity type:Individual
Prefix:
First Name:MURRAY
Middle Name:A
Last Name:WOLKSTEIN
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 1:200 S BROAD ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-5003
Mailing Address - Country:US
Mailing Address - Phone:201-445-6622
Mailing Address - Fax:201-445-0262
Practice Address - Street 1:200 S BROAD ST UNIT B
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-5003
Practice Address - Country:US
Practice Address - Phone:201-445-6622
Practice Address - Fax:201-445-0262
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA35598207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B12729Medicare UPIN
056907Medicare ID - Type Unspecified