1558529370 NPI number — DR. ELIZABETH RAPHAEL WOLFF MD

Table of content: DR. ELIZABETH RAPHAEL WOLFF MD (NPI 1558529370)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558529370 NPI number — DR. ELIZABETH RAPHAEL WOLFF MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOLFF
Provider First Name:
ELIZABETH
Provider Middle Name:
RAPHAEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1558529370
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26 COURT ST STE 811
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11242-1108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-935-6738
Provider Business Mailing Address Fax Number:
718-935-6100

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26 COURT ST
Provider Second Line Business Practice Location Address:
SUITE 914
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11242-0103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-935-6738
Provider Business Practice Location Address Fax Number:
718-935-6100
Provider Enumeration Date:
05/29/2008

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: 2084P0804X , with the licence number:  228096 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: 228096 , 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)





Copyright © 2007-2024 www.npivalidator.com