MEDICARE: DR. SUSAN ILENE WOLK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	183204	NY

General Provider Information

NPI Number	:	1013001593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN ILENE WOLK M.D.

Provider Business Mailing Address
First Line	:	275 CENTRAL PARK W
Second Line	:	SUITE 1F
City	:	NEW YORK
State	:	NY
Zip	:	10024-3015
Country	:	US
Telephone Number	:	212-874-6579
Fax Number	:	212-874-6579

Provider Business Practice Location Address
First Line	:	275 CENTRAL PARK W
Second Line	:	SUITE 1F
City	:	NEW YORK
State	:	NY
Zip	:	10024-3015
Country	:	US
Telephone Number	:	212-874-6579
Fax Number	:	212-874-6579

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	07/08/2007

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