MEDICARE: MS. PHYLLIS JOAN WOLFF N.P.

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	363LA2200X	Adult Health Nurse Practitioner	301342	NY

General Provider Information

NPI Number	:	1164471694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PHYLLIS JOAN WOLFF N.P.

Provider Business Mailing Address
First Line	:	1723 N OCEAN AVE
Second Line	:
City	:	MEDFORD
State	:	NY
Zip	:	11763-2649
Country	:	US
Telephone Number	:	631-758-5858
Fax Number	:

Provider Business Practice Location Address
First Line	:	1723 N OCEAN AVE
Second Line	:
City	:	MEDFORD
State	:	NY
Zip	:	11763-2649
Country	:	US
Telephone Number	:	631-758-5858
Fax Number	:

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

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	08/13/2012

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