Provider Demographics
NPI:1275844516
Name:DELGADO, WILSON EDUARDO (MD)
Entity Type:Individual
Prefix:
First Name:WILSON
Middle Name:EDUARDO
Last Name:DELGADO
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 1:411 CORTLANDT ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-3203
Mailing Address - Country:US
Mailing Address - Phone:973-459-5938
Mailing Address - Fax:
Practice Address - Street 1:4201 NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-4929
Practice Address - Country:US
Practice Address - Phone:201-601-9515
Practice Address - Fax:201-601-9516
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09263600208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics