Provider Demographics
NPI:1871204743
Name:WILSON, CLAUDE A
Entity type:Individual
Prefix:MR
First Name:CLAUDE
Middle Name:A
Last Name:WILSON
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 1:31 FLEET WALK
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-3192
Mailing Address - Country:US
Mailing Address - Phone:171-859-6639
Mailing Address - Fax:
Practice Address - Street 1:31 FLEET WALK
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-3192
Practice Address - Country:US
Practice Address - Phone:171-859-6639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities