Robert Wilson, MT CLT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

18KT01301400

Practice address

66 Newark Pompton Tpke
Riverdale, NJ 07457-1420

Phone

(973) 858-9000

NPI assigned

Nov 17, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Medical Technician

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Avant Garde Total Wellness Centers LLC

  • Massage Therapist
  • Riverdale, NJ
  • NPI 1184380230

  Single Specialty

  NPD Authorized official

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

{
    "created_epoch": "1637107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637107200000",
    "number": "1255098919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1151 MACOPIN RD",
            "city": "WEST MILFORD",
            "state": "NJ",
            "postal_code": "074801508",
            "telephone_number": "201-615-7317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "66 NEWARK POMPTON TPKE",
            "city": "RIVERDALE",
            "state": "NJ",
            "postal_code": "074571420",
            "telephone_number": "973-858-9000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "ROBERT",
        "credential": "MT CLT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-11-17",
        "last_updated": "2021-11-17",
        "certification_date": "2021-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Massage Therapist",
            "state": null,
            "license": "18KT01301400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wal-Mart Stores East, LP (Vision Center 30-3443)
• Tiffany Warren
• Heather Diane Weglinski, RN, BSN
• Jeffrey G Weiss, MD
• Kaya T Williams, LMT
• Shaina Woodward
• Joseph Young, D.C
• Ryan Zlotkowski, DMD

• Massage Therapist in Riverdale, NJ
• Providers in Riverdale, NJ by specialty
• Massage Therapist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.