Provider Demographics
NPI:1225541022
Name:DENISE C. WOLKEN, MD PLLC
Entity type:Organization
Organization Name:DENISE C. WOLKEN, MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:C
Authorized Official - Last Name:WOLKEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-991-4180
Mailing Address - Street 1:115 WOODSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13224-1831
Mailing Address - Country:US
Mailing Address - Phone:315-415-0886
Mailing Address - Fax:
Practice Address - Street 1:4000 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 214
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-6624
Practice Address - Country:US
Practice Address - Phone:315-991-4180
Practice Address - Fax:315-991-4046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-15
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190114208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty