Healthcare Provider Details

I. General information

NPI: 1699764647
Provider Name (Legal Business Name): MARTIN SLOANE WOLFSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 BROADWAY
NEWBURGH NY
12550
US

IV. Provider business mailing address

141 BROADWAY
NEWBURGH NY
12550
US

V. Phone/Fax

Practice location:
  • Phone: 845-568-5260
  • Fax: 845-568-5213
Mailing address:
  • Phone: 845-568-5260
  • Fax: 845-568-5213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number1233131
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: