Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 121280 | NY |
NPI | 1285031492 |
---|---|
Provider Name | Dr. Stephen Jay Wilson |
First Address | Merrick, NY 11566-1208 |
Second Address | Merrick, NY 11566-1208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2014 |
Last Update Date | 03/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C08036 | (02) | NY |