Healthcare Provider Details

I. General information

NPI: 1457377665
Provider Name (Legal Business Name): MITCHELL WOLFSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 MILL CRK N
ROSLYN NY
11576-1647
US

IV. Provider business mailing address

804 MILL CRK N
ROSLYN NY
11576-1647
US

V. Phone/Fax

Practice location:
  • Phone: 914-484-6051
  • Fax: 516-706-0331
Mailing address:
  • Phone: 914-484-6051
  • Fax: 516-706-0331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number135548
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: