Individual
JOSEPH WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
273 HEBERTON AVENUE, STATEN ISLAND, NY 10302
(718) 412-3170
Mailing address
273 HEBERTON AVENUE, STATEN ISLAND, NY 10302
(718) 412-3170
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
03/30/2017
Last updated
03/30/2017
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