Healthcare Provider Details

I. General information

NPI: 1346434966
Provider Name (Legal Business Name): WILGYMS ST. HILAIRE NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11835 QUEENS BLVD STE 400
FOREST HILLS NY
11375-7211
US

IV. Provider business mailing address

1416 MADISON ST
ELMONT NY
11003-1308
US

V. Phone/Fax

Practice location:
  • Phone: 646-722-7610
  • Fax:
Mailing address:
  • Phone: 516-680-3622
  • Fax: 516-616-5449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number335272
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: