Healthcare Provider Details

I. General information

NPI: 1306842000
Provider Name (Legal Business Name): HOWARD WULFSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 06/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 JERICHO TPKE
SYOSSET NY
11791-4515
US

IV. Provider business mailing address

66 POWERHOUSE RD FL 3
ROSLYN HTS NY
11577-1324
US

V. Phone/Fax

Practice location:
  • Phone: 516-496-6500
  • Fax:
Mailing address:
  • Phone: 516-945-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number108874
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: