Provider Demographics
NPI:1972760791
Name:WOLKOFF, ALBERT (MD)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:
Last Name:WOLKOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 HAWLEY ST
Mailing Address - Street 2:6TH FLOOR,WEST TOWER
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13901-3216
Mailing Address - Country:US
Mailing Address - Phone:607-722-1170
Mailing Address - Fax:
Practice Address - Street 1:20 HAWLEY ST
Practice Address - Street 2:6TH FLOOR,WEST TOWER
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13901-3216
Practice Address - Country:US
Practice Address - Phone:607-722-1170
Practice Address - Fax:607-722-7559
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1073482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00597008Medicaid
NY1528007572OtherNPI
NY00597008Medicaid