Individual
CHARNELE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1985 MARCUS AVE, NEW HYDE PARK, NY 11042-2008
(718) 380-7600
Mailing address
3639 HOLLAND AVE APT 2F, BRONX, NY 10467-5948
(917) 804-6773
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6004868721296852033
—
NY
Enumeration date
09/19/2019
Last updated
09/19/2019
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