1861402828 NPI number — STEVEN U WOLF DO

Table of content: STEVEN U WOLF DO (NPI 1861402828)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861402828 NPI number — STEVEN U WOLF DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOLF
Provider First Name:
STEVEN
Provider Middle Name:
U
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1861402828
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9331 OLD BUSTLETON AVE
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19115-4204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-673-7070
Provider Business Mailing Address Fax Number:
215-673-2828

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9331 OLD BUSTLETON AVE
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19115-4204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-673-7070
Provider Business Practice Location Address Fax Number:
215-673-2828
Provider Enumeration Date:
08/09/2006

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: 207R00000X , with the licence number:  OS009131L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CD4829 . This is a "TPI GROUP RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1007278000 . This is a "TPI GROUP MEDICAID ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0017390260001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0706166000 . This is a "IBC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 597586 . This is a "TPI MEDICARE GROUP ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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