Organization
NORTHERN VALLEY ANESTHESIOLOGY, P.A.
Active
Organization
NORTHERN VALLEY ANESTHESIOLOGY, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACEY MICHELLE WILSON (DIRECTOR)
(865) 985-7114
Entity
Organization
Contact information
Practice address
350 ENGLE ST, ENGLEWOOD, NJ 07631-1808
(201) 871-6073
(201) 871-0619
Mailing address
265 BROOKVIEW CENTRE WAY STE 203, KNOXVILLE, TN 37919-4053
(865) 985-7114
(865) 692-5867
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01357648
NEW YORK STATE MEDICAID
NY
05
—
2547406
—
NJ
01
—
CM1039
RAILROAD MEDICARE
NJ
Enumeration date
05/07/2006
Last updated
06/05/2026
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