Individual
MR. JERRY WOLBERT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN FNP
Contact information
Practice address
227 MADISON ST, GOUVERNEUR MEDICAL STAFF OFFICE , R-1249, NEW YORK, NY 10002-7537
(212) 238-7614
(212) 238-7009
Mailing address
45 TIEMANN PL, #2R, NEW YORK, NY 10027
(212) 387-7400
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
F330202
NY
Other
Enumeration date
06/04/2006
Last updated
07/23/2010
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