Provider Demographics
NPI:1316058167
Name:WOLFE, SUSAN GELLER (RDH)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:GELLER
Last Name:WOLFE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 HOWE RD
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-1830
Mailing Address - Country:US
Mailing Address - Phone:631-698-8524
Mailing Address - Fax:
Practice Address - Street 1:3 CANTERBURY DR
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-3315
Practice Address - Country:US
Practice Address - Phone:631-265-0606
Practice Address - Fax:631-265-6275
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0126-27-1124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist