Healthcare Provider Details

I. General information

NPI: 1093145989
Provider Name (Legal Business Name): RENEE WOHLTMAN P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2013
Last Update Date: 11/14/2013
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

52 CLINTON AVE
PLEASANTVILLE NY
10570-3252
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-9177
  • Fax:
Mailing address:
  • Phone: 925-864-4168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number017139-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: