Provider Demographics
NPI:1154533479
Name:WOLF, ELANA SHANA (DMD)
Entity type:Individual
Prefix:
First Name:ELANA
Middle Name:SHANA
Last Name:WOLF
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 MARKET ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07505-1471
Mailing Address - Country:US
Mailing Address - Phone:973-742-4200
Mailing Address - Fax:973-742-4997
Practice Address - Street 1:140 MARKET ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07505-1471
Practice Address - Country:US
Practice Address - Phone:973-742-4200
Practice Address - Fax:973-742-4997
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI021884001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0129879Medicaid