Individual
DR. KENNETH W WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
45 READE PL, JOSEPH TOWER, 1ST FLOOR, POUGHKEEPSIE, NY 12601-3947
(845) 483-6654
Mailing address
1351 ROUTE 55 STE 200, LAGRANGEVILLE, NY 12540-5128
(845) 483-6654
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
194765
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
194765
LICENSE #
NY
Enumeration date
12/18/2006
Last updated
09/24/2012
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