Provider Demographics
NPI:1174814735
Name:WILKEN, REASON (MD)
Entity Type:Individual
Prefix:DR
First Name:REASON
Middle Name:
Last Name:WILKEN
Suffix:
Gender:F
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:NORTHWELL HEALTH DERMATOLOGY
Mailing Address - Street 2:1991 MARCUS AVENUE SUITE 300
Mailing Address - City:NORTH NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:10042-3300
Mailing Address - Country:US
Mailing Address - Phone:516-719-3376
Mailing Address - Fax:
Practice Address - Street 1:1991 MARCUS AVE STE 300
Practice Address - Street 2:
Practice Address - City:NORTH NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-2058
Practice Address - Country:US
Practice Address - Phone:516-321-8551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-29
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY298778-1207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery