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General NPI Number Information
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NPI Number | 1134315104
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Entity Type | Organization
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Legal Business Name | KENNETH J WOLF MD PC
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Dates
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Enumeration Date | 09/24/2007
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Last Update Date | 09/24/2007
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Provider Practice Location Address
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Address Line | 1180 MORRIS PARK AVE
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City | BRONX
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State | NY
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Zip | 10461-1925
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Country | US
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Telephone | 718-892-6110
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Fax | 718-892-6111
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Provider Business Mailing Address
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Address Line | 1180 MORRIS PARK AVE
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City | BRONX
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State | NY
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Zip | 10461-1925
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Country | US
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Telephone | 718-892-6110
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Fax | 718-892-6111
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Authorized Official
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Title or Position | PRES
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Name | DR. KENNETH JOEL WOLF
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Credential | MD
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Telephone | 718-892-6110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 123855
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License Number State | NY
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