Doctor Name: | MR. JASON ANDREW WOLK |
NPI Number: | 1407013477 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | RN |
License Number: | 528454-1 |
Business Practice Address: | 26 Winding Path Apt 15 Manorville, NY - 119492258 |
Business Phone Number: | 5169876607 |
Business Fax Number: | |
Mailing Address: | 26 Winding Path Apt 15, MANORVILLE |
State: | NY |
Postal Code: | 119492258 |
Phone Number: | 5169876607 |
Fax Number: | |
NPI Enumeration Date: | 05/19/2008 |
NPI Last Update Date: | 05/19/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 163WP0200X |
License Number: | 528454-1 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Nursing Service Providers |
Taxonomy Classification: | Registered Nurse |
Taxonomy Specialization: | Pediatrics |
Taxonomy Definition: |