Healthcare Provider Details

I. General information

NPI: 1801998950
Provider Name (Legal Business Name): DAVID CARY WOLF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 11/30/2021
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WOODS RD TRANSPLANT DEPARTMENT -A WING LOWER LEVEL
VALHALLA NY
10595-1530
US

IV. Provider business mailing address

19 BRADHURST AVE SUITE 3100N
HAWTHORNE NY
10532-2140
US

V. Phone/Fax

Practice location:
  • Phone: 914-493-8916
  • Fax: 914-493-1097
Mailing address:
  • Phone: 914-909-9018
  • Fax: 914-909-9028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RT0003X
TaxonomyTransplant Hepatology Physician
License Number167057
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number167057
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: