Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 25MA03369200 | NJ |
NPI | 1124291612 |
---|---|
Provider Name | Dr. John G Wilson |
First Address | Merchantville, NJ 08109-2213 |
Second Address | Merchantville, NJ 08109-2213 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2008 |
Last Update Date | 07/04/2008 |