Provider Demographics
NPI:1871765453
Name:WOLK, ERIC TODD (DO)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:TODD
Last Name:WOLK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 S 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:LONGPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:08403-1214
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1925 PACIFIC AVE
Practice Address - Street 2:DEPT OF EMERGENCY MEDICINE
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-6713
Practice Address - Country:US
Practice Address - Phone:609-345-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-24
Last Update Date:2009-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08378600207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ127440UKEMedicare PIN
NJ127440ZEDBMedicare PIN
NJP00656936Medicare PIN