Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207NS0135X | Procedural Dermatology | 153906 | NY |
NPI | 1407940687 |
---|---|
Provider Name | Dr. Nancy Sue Wolfin |
First Address | Great Neck, NY 11023-2432 |
Second Address | Great Neck, NY 11023-2432 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A64135 | (02) | NY |