Provider Demographics
NPI:1104886530
Name:WOLF-GREENWALD, BONNIE M (MD)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:M
Last Name:WOLF-GREENWALD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1722
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10602-1722
Mailing Address - Country:US
Mailing Address - Phone:914-683-0443
Mailing Address - Fax:914-683-8620
Practice Address - Street 1:170 MAPLE AVE
Practice Address - Street 2:G1
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-4710
Practice Address - Country:US
Practice Address - Phone:914-683-0443
Practice Address - Fax:914-683-8620
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212629207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH25982Medicare UPIN
NY86019TE381Medicare PIN