Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | X010095-1 | NY |
NPI | 1659454981 |
---|---|
Provider Name | Dr. Stephen Louis Wiklinski |
First Address | Old Tappan, NJ 07675-7013 |
Second Address | Tarrytown, NY 10591-3660 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 08/07/2007 |