Healthcare Provider Details

I. General information

NPI: 1972755445
Provider Name (Legal Business Name): DIANA SALLY WOLFE MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2008
Last Update Date: 11/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E 233RD ST
BRONX NY
10466-2604
US

IV. Provider business mailing address

1825 EASTCHESTER RD ROOM 701
BRONX NY
10461-2301
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-9647
  • Fax:
Mailing address:
  • Phone: 718-904-2767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MA08489800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberA108770
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number266443
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: