Individual
OMAR WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
70 RIDGE RD, LYNDHURST, NJ 07071-1216
(201) 992-0183
(201) 984-4429
Mailing address
576 BROADHOLLOW RD, MELVILLE, NY 11747-5002
(631) 359-5800
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
40QB00280300
NJ
Other
Enumeration date
04/26/2023
Last updated
04/26/2023
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