Healthcare Provider Details

I. General information

NPI: 1598762437
Provider Name (Legal Business Name): EDWIN WILLIAM WOLF DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 03/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WEST 85TH STREET SUITE 1C
NEW YORK NY
10024
US

IV. Provider business mailing address

1 WEST 85TH STREET SUITE 1C
NEW YORK NY
10024
US

V. Phone/Fax

Practice location:
  • Phone: 212-874-0564
  • Fax:
Mailing address:
  • Phone: 212-874-0564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberN2630
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberN2630
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: