Individual
MICHAEL WESSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
223 N VAN DIEN AVE, RIDGEWOOD, NJ 07450-2726
(201) 634-5403
(201) 252-8472
Mailing address
1244 LINCOLN AVE, POMPTON LAKES, NJ 07442-1420
(862) 666-9200
(862) 666-9204
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
1640601
NY
2085R0001X
Radiation Oncology Physician
Primary
25MA05805500
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01195151
—
NY
05
—
5515009
—
NJ
Enumeration date
05/23/2006
Last updated
06/25/2016
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