Healthcare Provider Details

I. General information

NPI: 1427102110
Provider Name (Legal Business Name): SUSAN A WOLF MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 11/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 TERRACE AVENUE
HASBROUCK HEIGHTS NJ
07604
US

IV. Provider business mailing address

214 TERRACE AVENUE
HASBROUCK HEIGHTS NJ
07604
US

V. Phone/Fax

Practice location:
  • Phone: 201-288-6330
  • Fax: 201-288-6331
Mailing address:
  • Phone: 201-288-6330
  • Fax: 201-288-6331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number168445
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number168445
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number25MA05184600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: