Provider Demographics
NPI:1447513106
Name:JOHN J WILKINS,D.O.,P.A.
Entity type:Organization
Organization Name:JOHN J WILKINS,D.O.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:856-983-5551
Mailing Address - Street 1:239 TAUNTON BLVD
Mailing Address - Street 2:A-2
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-3471
Mailing Address - Country:US
Mailing Address - Phone:856-983-5551
Mailing Address - Fax:856-983-1511
Practice Address - Street 1:239 TAUNTON BLVD
Practice Address - Street 2:A-2
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-3471
Practice Address - Country:US
Practice Address - Phone:856-983-5551
Practice Address - Fax:856-983-1511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB050765002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty