Individual provider Active NPI

Wilson Antoine, M.D.

  • Internal Medicine Physician
  • Newark, NJ
National Provider Identifier
1043320559
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
44539 Issued in NJ
Practice address
52 Underwood St
Newark, NJ 07106-3721
Phone
(973) 372-4937
Fax
(973) 372-4937
NPI assigned
Aug 30, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 44539 NJ Primary

Addresses

Primary practice location

52 Underwood St
Newark, NJ 07106-3721

Mailing address

52 Underwood St
Newark, NJ 07106-3721
Phone (973) 372-4937

Other identifiers 1

IdentifierTypeStateIssuer
1147803MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101220000120 NJ Practitioner - Internal Medicine 2264620152 Practice locations: Newark, NJ

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

52 -4 Underwood St
Newark, NJ 07106-3721
Phone (973) 372-4937

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
44539NJMDInternal Medicine Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1043320559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "52 UNDERWOOD ST",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071063721",
            "telephone_number": "973-372-4937",
            "fax_number": "973-372-4937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "52 UNDERWOOD ST",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071063721",
            "telephone_number": "973-372-4937",
            "fax_number": "973-372-4937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANTOINE",
        "first_name": "WILSON",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "44539",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1147803",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Newark, NJ

Sources for this page

Verify at the official NPI Registry.