Provider Demographics
NPI:1053422519
Name:WILSON, ARNOLD BRETT (MD)
Entity type:Individual
Prefix:
First Name:ARNOLD
Middle Name:BRETT
Last Name:WILSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 E GUN HILL RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2103
Mailing Address - Country:US
Mailing Address - Phone:718-798-1000
Mailing Address - Fax:718-798-5522
Practice Address - Street 1:75 E GUN HILL RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2103
Practice Address - Country:US
Practice Address - Phone:718-798-1000
Practice Address - Fax:718-798-5522
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY176426174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF83417Medicare UPIN
NY19J331Medicare ID - Type Unspecified