Provider Demographics
NPI:1851363964
Name:TILSON, MORRIS A (MD)
Entity Type:Individual
Prefix:DR
First Name:MORRIS
Middle Name:A
Last Name:TILSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1995 ROUTE 17M
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-5231
Mailing Address - Country:US
Mailing Address - Phone:845-294-5406
Mailing Address - Fax:845-294-7815
Practice Address - Street 1:1995 ROUTE 17M
Practice Address - Street 2:SUITE 1
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-5231
Practice Address - Country:US
Practice Address - Phone:845-294-5406
Practice Address - Fax:845-294-7815
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY114319-1207R00000X
NJ25MA03915300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ460013WC0Medicare PIN
NYA400073790Medicare PIN