MEDICARE: DR. OLGA WILDFEUER MD

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	207R00000X	Internal Medicine Physician	185089	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184652067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OLGA WILDFEUER MD

Provider Business Mailing Address
First Line	:	1400 5TH AVENUE
Second Line	:	7R
City	:	NEW YORK CITY
State	:	NY
Zip	:	10026-2588
Country	:	US
Telephone Number	:	212-369-8269
Fax Number	:	212-360-3919

Provider Business Practice Location Address
First Line	:	55 GREENE AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11238-6406
Country	:	US
Telephone Number	:	718-789-5900
Fax Number	:	718-233-3318

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

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	09/28/2011

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