MEDICARE: DR. ERIC JAY WOLF 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	207W00000X	Ophthalmology Physician	229282	NY

General Provider Information

NPI Number	:	1598796930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC JAY WOLF M.D.

Provider Business Mailing Address
First Line	:	8A FRANKLIN PL
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11023-1211
Country	:	US
Telephone Number	:	516-570-6186
Fax Number	:

Provider Business Practice Location Address
First Line	:	1180 MORRIS PARK AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-1925
Country	:	US
Telephone Number	:	718-892-6110
Fax Number	:	718-892-6111

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

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	07/08/2007

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