Healthcare Provider Details

I. General information

NPI: 1528008059
Provider Name (Legal Business Name): JEFFREY MOYER WOLFF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 02/24/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 W PITTSBURGH ST
GREENSBURG PA
15601-2211
US

IV. Provider business mailing address

801 YORK ST
MANITOWOC WI
54220-4630
US

V. Phone/Fax

Practice location:
  • Phone: 724-837-5810
  • Fax: 724-837-8938
Mailing address:
  • Phone: 920-663-9016
  • Fax: 920-684-1439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberMD022361E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207NI0002X
TaxonomyClinical & Laboratory Dermatological Immunology Physician
License NumberMD022361E
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberMD022361E
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD022361E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: