Healthcare Provider Details

I. General information

NPI: 1316505696
Provider Name (Legal Business Name): CHRISTOPHER WILKINSON FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2019
Last Update Date: 06/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1468 MADISON AVE
NEW YORK NY
10029-6508
US

IV. Provider business mailing address

491 E 140TH ST APT 2
BRONX NY
10454-2795
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-5566
  • Fax:
Mailing address:
  • Phone: 646-201-1409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF344074-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: