Individual
LISA J WOLF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
400 PATROON CREEK BLVD, SUITE 1, ALBANY, NY 12206-5004
(518) 489-0044
(518) 489-3591
Mailing address
400 PATROON CREEK BLVD, SUITE 1, ALBANY, NY 12206-5004
(518) 489-0044
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
011597
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P01083127
RAILROAD MEDICARE
NY
Enumeration date
01/25/2006
Last updated
07/16/2014
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