=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942455480
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SCHOOL STREET ANESTHESIA, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/25/2008
-----------------------------------------------------
Last Update Date | 11/25/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2415 JERUSALEM AVE SUITE 100
-----------------------------------------------------
City | NORTH BELLMORE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11710-1870
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-640-5863
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 709
-----------------------------------------------------
City | GLEN COVE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11542-0709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-640-5863
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DENNIS WOLF
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 516-640-5863
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------