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General NPI Number Information
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NPI Number | 1346033313
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Entity Type | Individual
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Provider Name | JUSTIN WILSON
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Gender | Male
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Dates
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Enumeration Date | 05/23/2025
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Last Update Date | 05/23/2025
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Provider Practice Location Address
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Address Line | 524 WILLIAMSTOWN RD
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City | SICKLERVILLE
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State | NJ
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Zip | 08081-1800
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Country | US
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Telephone | 856-484-5510
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Fax | 856-335-3764
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Provider Business Mailing Address
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Address Line | 576 BROADHOLLOW RD
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City | MELVILLE
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State | NY
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Zip | 11747-5012
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Country | US
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Telephone | 631-359-5800
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Fax | 631-396-0864
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State |
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