Healthcare Provider Details

I. General information

NPI: 1598796930
Provider Name (Legal Business Name): ERIC JAY WOLF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 MORRIS PARK AVE
BRONX NY
10461-1925
US

IV. Provider business mailing address

8A FRANKLIN PL
GREAT NECK NY
11023-1211
US

V. Phone/Fax

Practice location:
  • Phone: 718-892-6110
  • Fax: 718-892-6111
Mailing address:
  • Phone: 516-570-6186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number229282
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: