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General NPI Number Information
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NPI Number | 1518787225
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Entity Type | Individual
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Provider Name | CHAYA DUSYA WILHELM FNP - BC
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Gender | Female
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Dates
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Enumeration Date | 10/16/2024
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Last Update Date | 10/16/2024
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Provider Practice Location Address
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Address Line | 1771 MADISON AVE
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City | LAKEWOOD
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State | NJ
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Zip | 08701-1242
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Country | US
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Telephone | 732-364-2144
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Fax |
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Provider Business Mailing Address
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Address Line | 37 NUSSBAUM AVE
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City | LAKEWOOD
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State | NJ
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Zip | 08701-4694
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Country | US
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Telephone | 732-966-2507
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26NJ15158800
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License Number State | NJ
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