Provider Demographics
NPI:1932419298
Name:WILSON, CARL T (343127-1)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:T
Last Name:WILSON
Suffix:
Gender:M
Credentials:343127-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 OLD POST RD
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NY
Mailing Address - Zip Code:12542-6544
Mailing Address - Country:US
Mailing Address - Phone:845-546-4245
Mailing Address - Fax:
Practice Address - Street 1:89 OLD POST RD
Practice Address - Street 2:
Practice Address - City:MARLBORO
Practice Address - State:NY
Practice Address - Zip Code:12542-6544
Practice Address - Country:US
Practice Address - Phone:845-546-4245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY343127-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse