Provider Demographics
NPI:1285786467
Name:JOEL C WOLF
Entity type:Organization
Organization Name:JOEL C WOLF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:CLIFFORD
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:732-350-1900
Mailing Address - Street 1:550 ROUTE 530
Mailing Address - Street 2:SUITE 19
Mailing Address - City:WHITING
Mailing Address - State:NJ
Mailing Address - Zip Code:08759-3140
Mailing Address - Country:US
Mailing Address - Phone:732-350-1900
Mailing Address - Fax:732-350-0093
Practice Address - Street 1:550 ROUTE 530
Practice Address - Street 2:SUITE 19
Practice Address - City:WHITING
Practice Address - State:NJ
Practice Address - Zip Code:08759-3140
Practice Address - Country:US
Practice Address - Phone:732-350-1900
Practice Address - Fax:732-350-0093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4577906Medicaid
NJ=========Medicare PIN
NJ0426350001Medicare NSC