Provider Demographics
NPI:1659406593
Name:WILSON, ABRALENA DE JESUS (DO)
Entity Type:Individual
Prefix:DR
First Name:ABRALENA
Middle Name:DE JESUS
Last Name:WILSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2000 N VILLAGE AVE STE 211
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-1001
Mailing Address - Country:US
Mailing Address - Phone:516-900-7922
Mailing Address - Fax:516-268-6398
Practice Address - Street 1:2000 N VILLAGE AVE STE 211
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-1001
Practice Address - Country:US
Practice Address - Phone:516-900-7922
Practice Address - Fax:516-268-6398
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2558932082S0105X, 208600000X, 2086S0102X, 2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care