SIDNEY RODOLFO WILSON PA12 NPI 1861439523

NPI Information

NPI: 1861439523
Provider Name: SIDNEY RODOLFO WILSON, PA12
Classification: Physician Assistant - 363AM0700X
Entity Type: Individual

Specialization: Medical

Address:
4115 162ND ST
FLUSHING, NY
ZIP 11358
Phone: (718) 762-6640
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Sidney Rodolfo Wilson, PA12 is a medical physician assistant in Flushing, NY. Sidney Rodolfo Wilson, PA12 NPI is 1861439523. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

4115 162ND ST
FLUSHING, NY
ZIP 11358-124
Phone: (718) 762-6640

The enumeration date for this NPI number is 6/1/2006 and was last updated on 5/4/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363AM0700X	Physician Assistant	Medical	006481	NEW YORK	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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