Healthcare Provider Details

I. General information

NPI: 1811315138
Provider Name (Legal Business Name): JOSEPH JAMES WOLF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOSEPH JAMES WOLF M.D.

II. Dates (important events)

Enumeration Date: 04/03/2014
Last Update Date: 04/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 GRAND ST
NEW BRITAIN CT
06052-2016
US

IV. Provider business mailing address

270 PARK AVE
HUNTINGTON NY
11743-2787
US

V. Phone/Fax

Practice location:
  • Phone: 860-224-5900
  • Fax: 860-224-5740
Mailing address:
  • Phone: 631-351-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number283620
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number62557
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: