MEDICARE: ABIGAIL C. WOLFSON CPNP

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	363LP0200X	Pediatric Nurse Practitioner	381807	NY

General Provider Information

NPI Number	:	1528253010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABIGAIL C. WOLFSON CPNP

Provider Business Mailing Address
First Line	:	610 HENRY ST
Second Line	:	PS 146, LICH CLINIC, ROOM 209
City	:	BROOKLYN
State	:	NY
Zip	:	11231-2612
Country	:	US
Telephone Number	:	718-923-4624
Fax Number	:	718-923-4632

Provider Business Practice Location Address
First Line	:	610 HENRY ST
Second Line	:	PS 146, LICH CLINIC, ROOM 209
City	:	BROOKLYN
State	:	NY
Zip	:	11231-2612
Country	:	US
Telephone Number	:	718-923-4624
Fax Number	:	718-923-4632

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

Provider Enumeration Date	:	09/08/2007
Last Update Date	:	09/08/2007

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