Provider Demographics
NPI:1780054155
Name:FIGUEREO, WILKIS
Entity type:Individual
Prefix:
First Name:WILKIS
Middle Name:
Last Name:FIGUEREO
Suffix:
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 1:45 E MADISON AVE
Mailing Address - Street 2:2ND FLOOR SUITE 1
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-2381
Mailing Address - Country:US
Mailing Address - Phone:862-414-0682
Mailing Address - Fax:
Practice Address - Street 1:45 E MADISON AVE
Practice Address - Street 2:2ND FLOOR SUITE 1
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-2381
Practice Address - Country:US
Practice Address - Phone:862-414-0682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ939654174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist