Individual
GENIENE E WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
8 BELLOWS LN, WOODSTOCK, NY 12498-1204
(845) 444-1221
(888) 395-6037
Mailing address
8 BELLOWS LN, WOODSTOCK, NY 12498-1204
(845) 444-1221
(888) 395-6037
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
017168
ME
207Q00000X
Family Medicine Physician
Primary
252714
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1679596738
NPI
ME
05
—
432427599
—
ME
05
—
PENDING
—
ME
Enumeration date
07/26/2006
Last updated
12/13/2018
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