Provider Demographics
NPI:1740257252
Name:WILSON, JEANNE MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:MARIE
Last Name:WILSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 BRADHURST AVE.,
Mailing Address - Street 2:CHILDREN'S & WOMEN'S PHYSICIANS OF WESTCHESTER
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532
Mailing Address - Country:US
Mailing Address - Phone:914-593-8850
Mailing Address - Fax:914-593-8833
Practice Address - Street 1:19 BRADHURST AVE.,
Practice Address - Street 2:CHILDREN'S & WOMEN'S PHYSICIANS OF WESTCHESTER
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532
Practice Address - Country:US
Practice Address - Phone:914-593-8850
Practice Address - Fax:914-593-8833
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205791208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01850068Medicaid
G44164Medicare UPIN