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NPI Code Detail

MEDICARE: ERROL ALEXANDER WILSON DDS

MEDICARE: ERROL ALEXANDER WILSON DDS
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
1122300000XDentist408177NY

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 : 1649288978
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERROL ALEXANDER WILSON DDS
Provider Business Mailing Address
First Line : 2570 ROUTE 9W STE 10
Second Line :
City : CORNWALL
State : NY
Zip : 12518-1370
Country : US
Telephone Number : 845-220-3100
Fax Number : 845-534-2940
Provider Business Practice Location Address
First Line : 147 LAKE ST
Second Line :
City : NEWBURGH
State : NY
Zip : 12550-5263
Country : US
Telephone Number : 845-563-8000
Fax Number : 845-534-2940
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2006
Last Update Date : 07/16/2019

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Directions to “ ERROL ALEXANDER WILSON DDS” Practice Location

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