Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 38MC00323800 | NJ |
NPI | 1003906447 |
---|---|
Provider Name | Dr. Richard Jay Wolf |
First Address | Maplewood, NJ 07040 |
Second Address | Maplewood, NJ 07040 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2006 |
Last Update Date | 08/07/2007 |