Individual
DR. JESSIE SWAIN WILT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
140 PARK AVE, FLORHAM PARK, NJ 07932
(973) 404-9930
Mailing address
1 DIAMOND HILL RD, BERKELEY HEIGHTS, NJ 07922-2104
(908) 277-8674
(908) 277-8927
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
207863
NY
207RP1001X
Pulmonary Disease Physician
Primary
25MA09052000
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01959544
—
NY
Enumeration date
11/02/2006
Last updated
02/21/2017
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