Healthcare Provider Details

I. General information

NPI: 1881830792
Provider Name (Legal Business Name): PAUL JOHN WOLFE CERTIFIED PEORTHIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2008
Last Update Date: 12/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ROUTE 90
CASTLE POINT NY
12511
US

IV. Provider business mailing address

423 E 23RD ST 14TH FLOOR PROSTHETIC SVC
NEW YORK NY
10010-5011
US

V. Phone/Fax

Practice location:
  • Phone: 845-831-2000
  • Fax: 845-838-5202
Mailing address:
  • Phone: 212-686-7500
  • Fax: 212-951-3333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberCPED1274
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number225000000X
License Number State
# 4
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberCPED1294
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: