Healthcare Provider Details

I. General information

NPI: 1336633890
Provider Name (Legal Business Name): MARIUSZ PIOTR WOLBINSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 07/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 FORT WASHINGTON AVE FL 6
NEW YORK NY
10032
US

IV. Provider business mailing address

630 W 168TH ST # 4
NEW YORK NY
10032-3725
US

V. Phone/Fax

Practice location:
  • Phone: 212-342-0444
  • Fax: 212-342-3640
Mailing address:
  • Phone: 212-342-0444
  • Fax: 212-342-3640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number292352
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: