1881107332 NPI number — MARISA WOLFF DO PLLC

Table of content: (NPI 1881107332)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881107332 NPI number — MARISA WOLFF DO PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARISA WOLFF DO PLLC
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:
6
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:
1881107332
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18 CONGRESS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SARATOGA SPRINGS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12866-4171
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-350-4694
Provider Business Mailing Address Fax Number:
518-350-6563

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18 CONGRESS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SARATOGA SPRINGS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12866-4171
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-350-4694
Provider Business Practice Location Address Fax Number:
518-309-6563
Provider Enumeration Date:
11/07/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WOLFF
Authorized Official First Name:
MARISA
Authorized Official Middle Name:
Authorized Official Title or Position:
SOLE MEMEBER
Authorized Official Telephone Number:
518-350-4694

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  271334 , 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)