Individual provider Active NPI

Denise Wolken, M.D.

  • Pediatrics Physician
  • Fayetteville, NY
National Provider Identifier
1356361646
Registry record updated Jul 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
190114 Issued in NY
Practice address
4000 Medical Center Dr
Suite 214
Fayetteville, NY 13066-6617
Phone
(315) 991-4180
Fax
(315) 991-4046
NPI assigned
Jul 20, 2006
Last updated
Jul 1, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 190114 NY Primary

Addresses

Primary practice location

4000 Medical Center Dr
Suite 214
Fayetteville, NY 13066-6617

Mailing address

4000 Medical Center Dr
Suite 214
Fayetteville, NY 13066-6617
Phone (315) 991-4180

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
190114NYMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Denise C. Wolken, MD PLLC Pediatrics Current Accepting new patients

Locations

4000 Medical Center Dr
Ste 214
Fayetteville, NY 13066
Phone (315) 329-4968

6851 E Genesee St
Fayetteville, NY 13066
Phone (315) 446-4580

Interoperability endpoints

  • Direct secure messaging: drwolken@wolkenpeds.opdirect.net
  • Direct secure messaging: dwolken@hiemail.healtheconnections.org

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719792000000",
    "number": "1356361646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 MEDICAL CENTER DR",
            "address_2": "SUITE 214",
            "city": "FAYETTEVILLE",
            "state": "NY",
            "postal_code": "130666617",
            "telephone_number": "315-991-4180",
            "fax_number": "315-991-4046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 MEDICAL CENTER DR",
            "address_2": "SUITE 214",
            "city": "FAYETTEVILLE",
            "state": "NY",
            "postal_code": "130666617",
            "telephone_number": "315-991-4180",
            "fax_number": "315-991-4046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLKEN",
        "first_name": "DENISE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-20",
        "last_updated": "2024-07-01",
        "certification_date": "2024-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "190114",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.