Provider Demographics
NPI:1770012262
Name:ALBARRACIN, WILSON MELECIO II
Entity Type:Individual
Prefix:MR
First Name:WILSON
Middle Name:MELECIO
Last Name:ALBARRACIN
Suffix:II
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 1:87-65 96TH ST.
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421
Mailing Address - Country:US
Mailing Address - Phone:646-291-7480
Mailing Address - Fax:
Practice Address - Street 1:161-10 JAMAICA AVE 2ND FL
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432
Practice Address - Country:US
Practice Address - Phone:718-704-5488
Practice Address - Fax:718-704-5486
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU0174136803Medicaid