Provider Demographics
NPI:1518122753
Name:WILSON, P.A.
Entity Type:Organization
Organization Name:WILSON, P.A.
Other - Org Name:CEDAR GROVE ANIMAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIPAT
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-239-3500
Mailing Address - Street 1:370 POMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07009-2030
Mailing Address - Country:US
Mailing Address - Phone:973-239-3500
Mailing Address - Fax:973-239-8476
Practice Address - Street 1:370 POMPTON AVE
Practice Address - Street 2:
Practice Address - City:CEDAR GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07009-2030
Practice Address - Country:US
Practice Address - Phone:973-239-3500
Practice Address - Fax:973-239-8476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital