Individual
DR. WILSON BOURJOLLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5141 BROADWAY, NEW YORK, NY 10034-1159
(212) 305-5138
(212) 305-2843
Mailing address
630 W 168TH ST # 4, NEW YORK, NY 10032-3725
(212) 305-5138
(212) 305-2843
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
224422
NY
208M00000X
Hospitalist Physician
Primary
224422
NY
Other
Enumeration date
11/22/2006
Last updated
07/21/2022
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