Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 161067 | NY |
NPI | 1003981481 |
---|---|
Provider Name | Dennis Wolf |
First Address | New York, NY 10087-5024 |
Second Address | New York, NY 10029-6504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2006 |
Last Update Date | 12/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
015777715 | (05) | NY |
A400122410 | (02) | NY |