Provider Demographics
NPI:1568944924
Name:GO, WILSON JR
Entity Type:Individual
Prefix:
First Name:WILSON
Middle Name:
Last Name:GO
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 SUNNYVIEW OVAL
Mailing Address - Street 2:
Mailing Address - City:KEASBEY
Mailing Address - State:NJ
Mailing Address - Zip Code:08832
Mailing Address - Country:US
Mailing Address - Phone:862-371-0082
Mailing Address - Fax:
Practice Address - Street 1:10 STERLING DRIVE
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854
Practice Address - Country:US
Practice Address - Phone:732-917-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-03
Last Update Date:2018-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00643900225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist