Provider Demographics
NPI:1881107332
Name:MARISA WOLFF DO PLLC
Entity type:Organization
Organization Name:MARISA WOLFF DO PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMEBER
Authorized Official - Prefix:
Authorized Official - First Name:MARISA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLFF
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:518-350-4694
Mailing Address - Street 1:18 CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-4171
Mailing Address - Country:US
Mailing Address - Phone:518-350-4694
Mailing Address - Fax:518-350-6563
Practice Address - Street 1:18 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-4171
Practice Address - Country:US
Practice Address - Phone:518-350-4694
Practice Address - Fax:518-309-6563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-07
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY271334207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty