Provider Demographics
NPI:1184700148
Name:WOLFF, DANIEL CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:CHARLES
Last Name:WOLFF
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 1:101 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18337-1203
Mailing Address - Country:US
Mailing Address - Phone:845-856-1118
Mailing Address - Fax:845-856-1120
Practice Address - Street 1:29 B ORANGE ST
Practice Address - Street 2:
Practice Address - City:PORT JERVIS
Practice Address - State:NY
Practice Address - Zip Code:12771-1427
Practice Address - Country:US
Practice Address - Phone:845-856-1118
Practice Address - Fax:845-856-1120
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033344E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA111080Medicare ID - Type Unspecified
NY07E671Medicare ID - Type Unspecified
PAA60306Medicare UPIN
PA111080Medicare ID - Type Unspecified