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General NPI Number Information
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NPI Number | 1861559528
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Entity Type | Individual
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Provider Name | JOHN J. WILSON MD
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Gender | Male
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 10/16/2014
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Provider Practice Location Address
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Address Line | 2100 WESCOTT DR
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City | FLEMINGTON
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State | NJ
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Zip | 08822-4603
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Country | US
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Telephone | 609-429-0054
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 326
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City | FRANKLIN LAKES
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State | NJ
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Zip | 07417-0326
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Country | US
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Telephone | 609-429-0054
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 192403
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 25MA06319000
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License Number State | NJ
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