Healthcare Provider Details

I. General information

NPI: 1255745360
Provider Name (Legal Business Name): ISRAEL WULLIGER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 06/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1273 53RD ST
BROOKLYN NY
11219-3865
US

IV. Provider business mailing address

1233 E 32ND ST
BROOKLYN NY
11210-4742
US

V. Phone/Fax

Practice location:
  • Phone: 718-435-5700
  • Fax:
Mailing address:
  • Phone: 646-739-9008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number091234-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: