1336475193 NPI number — GEORGE WOOLF MD PC

Table of content: (NPI 1336475193)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336475193 NPI number — GEORGE WOOLF MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GEORGE WOOLF MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336475193
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 EAST MAIN STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDDLETOWN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10940-4088
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-342-3306
Provider Business Mailing Address Fax Number:
845-342-0111

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 EAST MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10940-4088
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-342-3306
Provider Business Practice Location Address Fax Number:
845-342-0111
Provider Enumeration Date:
10/28/2009

Additional Information

Authorized Official

Authorized Official Last Name:
WOOLF
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
845-342-3306

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  84949 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0015768 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0D2699 . This is a "HN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4230941 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 077212 . This is a "MVP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1000016205 . This is a "AFF" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10052706 . This is a "CDPHP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 217892 . This is a "WELLCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 40222P . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 46648747 . This is a "MULTI PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00129364 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P2106346 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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