Provider Demographics
NPI:1306900840
Name:DAVID S. WOLKSTEIN, M.D. PA
Entity type:Organization
Organization Name:DAVID S. WOLKSTEIN, M.D. PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:WOLKSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-964-8550
Mailing Address - Street 1:2333 MORRIS AVE
Mailing Address - Street 2:SUITE A9
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-5714
Mailing Address - Country:US
Mailing Address - Phone:908-964-8550
Mailing Address - Fax:
Practice Address - Street 1:2333 MORRIS AVE
Practice Address - Street 2:SUITE A9
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-5714
Practice Address - Country:US
Practice Address - Phone:908-964-8550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA 21063261QM2500X
NJMA21063261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Not Answered261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy