MEDICARE: WILSON MEDICAL CARE

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
1	2081N0008X	Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician	132240	NY

General Provider Information

NPI Number	:	1588911275
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILSON MEDICAL CARE

Provider Business Mailing Address
First Line	:	2 WILSON PL
Second Line	:
City	:	MOUNT VERNON
State	:	NY
Zip	:	10550-2602
Country	:	US
Telephone Number	:	914-664-5380
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 WILSON PL
Second Line	:
City	:	MOUNT VERNON
State	:	NY
Zip	:	10550-2602
Country	:	US
Telephone Number	:	914-664-5380
Fax Number	:

Authorized Official
Title or Position	:	CODER/COMPLIANCE
Name	:	MRS. LATISHA COLES
Credential	:	CPC
Telephone Number	:	917-767-9817

Provider Enumeration Date	:	08/13/2012
Last Update Date	:	08/13/2012

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Directions to “WILSON MEDICAL CARE ” Practice Location

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