Healthcare Provider Details

I. General information

NPI: 1710372008
Provider Name (Legal Business Name): JESSE WOLSTEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 MARYS AVE
KINGSTON NY
12401-5829
US

IV. Provider business mailing address

445 COUNTRY CLUB LN
KINGSTON NY
12401-8610
US

V. Phone/Fax

Practice location:
  • Phone: 845-450-5027
  • Fax:
Mailing address:
  • Phone: 347-835-3296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number294415
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: