Provider Demographics
NPI:1336475193
Name:GEORGE WOOLF MD PC
Entity Type:Organization
Organization Name:GEORGE WOOLF MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOLF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-342-3306
Mailing Address - Street 1:210 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-4088
Mailing Address - Country:US
Mailing Address - Phone:845-342-3306
Mailing Address - Fax:845-342-0111
Practice Address - Street 1:210 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-4088
Practice Address - Country:US
Practice Address - Phone:845-342-3306
Practice Address - Fax:845-342-0111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY84949207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0015768OtherGHI
NY0D2699OtherHN
NY4230941OtherAETNA
NY077212OtherMVP
NY1000016205OtherAFF
NY10052706OtherCDPHP
NY217892OtherWELLCARE
NY40222POtherHIP
NY46648747OtherMULTI PLAN
NY00129364Medicaid
NYP2106346OtherOXFORD
NY1000016205OtherAFF
NY147392Medicare PIN