Provider Demographics
NPI:1457303174
Name:WILSON, SYLVIA V (MD)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:V
Last Name:WILSON
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 1:2 SMITH ROAD
Mailing Address - Street 2:PO BOX 4556
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08754
Mailing Address - Country:US
Mailing Address - Phone:732-341-3371
Mailing Address - Fax:732-914-2011
Practice Address - Street 1:2 SMITH RD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755
Practice Address - Country:US
Practice Address - Phone:732-341-3371
Practice Address - Fax:732-914-2011
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA024578002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3468500Medicaid
WI52039Medicare ID - Type Unspecified
NJ3468500Medicaid