Organization
ISABELLE PONGE WILSON MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ISABELLE PONGE WILSON MD (DOCTOR)
(212) 679-4134
Entity
Organization
Contact information
Practice address
50 PARK AVE, NEW YORK, NY 10016-3075
(212) 679-4134
(212) 679-7079
Mailing address
50 PARK AVE, NEW YORK, NY 10016-3075
(212) 679-4134
(212) 679-7079
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
198244
NY
207ND0101X
MOHS-Micrographic Surgery Physician
198244
NY
207NS0135X
Procedural Dermatology Physician
Primary
198244
NY
Other
Enumeration date
04/02/2007
Last updated
01/03/2013
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