MEDICARE: A.D.J. WILSON LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0127X	Trauma Surgery Physician

General Provider Information

NPI Number	:	1962237933
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A.D.J. WILSON LLC

Provider Business Mailing Address
First Line	:	132 MYRTLE AVE APT 21
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-7925
Country	:	US
Telephone Number	:	215-370-2606
Fax Number	:

Provider Business Practice Location Address
First Line	:	132 MYRTLE AVE APT 21
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-7925
Country	:	US
Telephone Number	:	215-370-2606
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ABRALENA DE JESUS WILSON
Credential	:	DO
Telephone Number	:	215-370-2606

Provider Enumeration Date	:	09/07/2024
Last Update Date	:	09/20/2024

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