Healthcare Provider Details

I. General information

NPI: 1538371331
Provider Name (Legal Business Name): JAMES PETER WOLBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1ST AVE & 16TH ST BERNSTEIN PAVILION
NEW YORK NY
10003
US

IV. Provider business mailing address

199 CLINTON ST #4
BROOKLYN NY
11201-6259
US

V. Phone/Fax

Practice location:
  • Phone: 212-420-4566
  • Fax:
Mailing address:
  • Phone: 718-422-0192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number191703
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: