Organization
WILSON PHYSICAL MEDICINE LLC
Active
Organization
WILSON PHYSICAL MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAMELA EILEEN WILSON DC (OWNER)
(732) 842-7004
Entity
Organization
Contact information
Practice address
130 MAPLE AVE, SUITE 7A, RED BANK, NJ 07701-1734
(732) 842-7004
Mailing address
130 MAPLE AVE, SUITE 7A, RED BANK, NJ 07701-1734
(732) 842-7004
Taxonomy
Speciality
Code
Description
License number
State
111NR0400X
Rehabilitation Chiropractor
Primary
38MC00385100
NJ
174400000X
Specialist
40QA01025400
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1033232830
NPI ENTITY 1 INDIVIDUAL PROVIDER #
NJ
Enumeration date
06/21/2011
Last updated
11/09/2011
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