MEDICARE: DR. ABRALENA DE JESUS WILSON D.O

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	2082S0105X	Surgery of the Hand (Plastic Surgery) Physician	255893	NY
2	208600000X	Surgery Physician	255893	NY
3	208600000X	Surgery Physician	02006360A	IN
4	2086S0102X	Surgical Critical Care Physician	255893	NY
5	2086S0127X	Trauma Surgery Physician	255893	NY

General Provider Information

NPI Number	:	1659406593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ABRALENA DE JESUS WILSON D.O

Provider Business Mailing Address
First Line	:	500 MONTAUK HWY STE K
Second Line	:
City	:	WEST ISLIP
State	:	NY
Zip	:	11795-4419
Country	:	US
Telephone Number	:	516-969-1023
Fax Number	:	631-517-1557

Provider Business Practice Location Address
First Line	:	500 MONTAUK HIGHWAY, SUITE K
Second Line	:
City	:	WEST ISLIP
State	:	NY
Zip	:	11795-1179
Country	:	US
Telephone Number	:	516-969-1023
Fax Number	:	631-517-1557

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	10/06/2025

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