Healthcare Provider Details

I. General information

NPI: 1417812074
Provider Name (Legal Business Name): MATTHEW ROSENBLUM WOLFE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 CASTLE HILL AVE # 4813
BRONX NY
10462-4813
US

IV. Provider business mailing address

209 HERRICK AVE
TEANECK NJ
07666-4108
US

V. Phone/Fax

Practice location:
  • Phone: 718-863-0210
  • Fax:
Mailing address:
  • Phone: 617-913-0600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number065224
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: