1497897110 NPI number — DR. ADAM LAURANCE WOLLOWICK MD

Table of content: DR. ADAM LAURANCE WOLLOWICK MD (NPI 1497897110)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497897110 NPI number — DR. ADAM LAURANCE WOLLOWICK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOLLOWICK
Provider First Name:
ADAM
Provider Middle Name:
LAURANCE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1497897110
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3400 BAINBRIDGE AVE FL 6
Provider Second Line Business Mailing Address:
ORTHOPAEDIC SURGERY
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10467-2404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-920-5376
Provider Business Mailing Address Fax Number:
718-654-2396

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3400 BAINBRIDGE AVE.
Provider Second Line Business Practice Location Address:
MAP6, ORTHOPAEDIC SURGERY
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10467
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-920-5376
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207XS0117X , with the licence number:  225985 , 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)





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