Individual
SIDNEY RODOLFO WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA12
Contact information
Practice address
4115 162ND ST, FLUSHING, NY 11358-4124
(718) 762-6640
Mailing address
448 E 45TH ST, BROOKLYN, NY 11203-4120
(718) 287-5450
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
006481
NY
Other
Enumeration date
06/01/2006
Last updated
05/04/2010
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