Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 818 | NJ |
Y | 103T00000X | Psychologist | 818 | NJ |
NPI | 1003824947 |
---|---|
Provider Name | Mr. Neil B Wilson |
First Address | Teaneck, NJ 07666 |
Second Address | Teaneck, NJ 07666 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 08/07/2007 |