Individual
MR. DANIEL MARK WILSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPA-C
Contact information
Practice address
1000 MONTAUK HWY, WEST ISLIP, NY 11795-4927
(631) 376-4444
Mailing address
20 MALLARD RD, LEVITTOWN, NY 11756-4204
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
015362-1
NY
Other
Enumeration date
02/10/2012
Last updated
02/22/2012
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