Healthcare Provider Details

I. General information

NPI: 1285788067
Provider Name (Legal Business Name): YVONNE WOLODZKO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 11/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 STEWART AVE SUITE 306
GARDEN CITY NY
11530-4892
US

IV. Provider business mailing address

68 S SERVICE RD SUITE 305
MELVILLE NY
11747-2354
US

V. Phone/Fax

Practice location:
  • Phone: 516-222-0893
  • Fax:
Mailing address:
  • Phone: 516-945-3000
  • Fax: 516-945-3032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number164777
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: