Individual
JANIFER P WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
1650 GRAND CONCOURSE, BRONX, NY 10457-7606
(718) 960-2000
Mailing address
501 W 156TH ST, APT 21, NEW YORK, NY 10032-7702
(212) 234-7699
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
000355-1
NY
Other
Enumeration date
03/26/2007
Last updated
07/08/2007
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