Provider Demographics
NPI:1457418642
Name:WILGUCKI, JOHN D (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:WILGUCKI
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1500 SAINT GEORGES AVE
Mailing Address - Street 2:UNIT D
Mailing Address - City:AVENEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07001-1000
Mailing Address - Country:US
Mailing Address - Phone:732-388-3030
Mailing Address - Fax:732-388-3528
Practice Address - Street 1:1500 SAINT GEORGES AVE
Practice Address - Street 2:UNIT D
Practice Address - City:AVENEL
Practice Address - State:NJ
Practice Address - Zip Code:07001-1000
Practice Address - Country:US
Practice Address - Phone:732-388-3030
Practice Address - Fax:732-388-3528
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-12-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJMB56000207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
123015OtherAETNA PROVIDER NUMBER
NJ5805802Medicaid
NJWI718406Medicare PIN
NJ5805802Medicaid