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NPI Code Detail

MEDICARE: JUNE-ANN NICOLE WILSON MD

MEDICARE:   JUNE-ANN NICOLE WILSON  MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician053736GA
2207R00000XInternal Medicine Physician327186NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1174521322
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUNE-ANN NICOLE WILSON MD
Provider Business Mailing Address
First Line : 55 WATER ST FL 2
Second Line :
City : NEW YORK
State : NY
Zip : 10041-0010
Country : US
Telephone Number : 646-680-2888
Fax Number : 516-542-5556
Provider Business Practice Location Address
First Line : 546 EASTERN PARKWAY
Second Line :
City : BROOKLYN
State : NY
Zip : 11225-1604
Country : US
Telephone Number : 718-604-4800
Fax Number : 718-604-4828
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2005
Last Update Date : 04/05/2024

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Directions to “ JUNE-ANN NICOLE WILSON MD” Practice Location

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