Provider Demographics
NPI:1841465408
Name:WOLFSON, DEVORA R (MD)
Entity type:Individual
Prefix:DR
First Name:DEVORA
Middle Name:R
Last Name:WOLFSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 ALPS RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-6026
Mailing Address - Country:US
Mailing Address - Phone:973-696-8268
Mailing Address - Fax:973-696-6575
Practice Address - Street 1:257 ALPS RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-6026
Practice Address - Country:US
Practice Address - Phone:973-696-8268
Practice Address - Fax:973-696-6575
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02386800174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist