Healthcare Provider Details

I. General information

NPI: 1275844516
Provider Name (Legal Business Name): WILSON EDUARDO DELGADO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2010
Last Update Date: 07/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 NEW YORK AVE
UNION CITY NJ
07087-4929
US

IV. Provider business mailing address

411 CORTLANDT ST
BELLEVILLE NJ
07109-3203
US

V. Phone/Fax

Practice location:
  • Phone: 201-601-9515
  • Fax: 201-601-9516
Mailing address:
  • Phone: 973-459-5938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA09263600
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: