MEDICARE: YVONNE WOLODZKO 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	208000000X	Pediatrics Physician	164777	NY

General Provider Information

NPI Number	:	1285788067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YVONNE WOLODZKO MD

Provider Business Mailing Address
First Line	:	68 S SERVICE RD
Second Line	:	SUITE 305
City	:	MELVILLE
State	:	NY
Zip	:	11747-2354
Country	:	US
Telephone Number	:	516-945-3000
Fax Number	:	516-945-3032

Provider Business Practice Location Address
First Line	:	1101 STEWART AVE
Second Line	:	SUITE 306
City	:	GARDEN CITY
State	:	NY
Zip	:	11530-4892
Country	:	US
Telephone Number	:	516-222-0893
Fax Number	:

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

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	11/12/2009

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