Active NPI
Austin Wilson, D.M.D.
- Dentist
- Bronx, NY
National Provider Identifier
1255791935
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 059713-1
- Practice address
- 6118 Riverdale Ave
Bronx, NY 10471-1009 - Phone
- (347) 590-9915
- Fax
- (212) 202-6447
- NPI assigned
- Feb 24, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 059713-1 | NY | Primary |
Addresses
Primary practice location
6118 Riverdale Ave
Bronx, NY 10471-1009
Mailing address
203 18TH St
Brooklyn, NY 11215-5304
Phone (251) 769-9763
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20181023002659 | NY | Practitioner - Oral Surgery | 5092068924 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 059713-1 | NY | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1456272000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1547596800000",
"number": "1255791935",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "203 18TH ST",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112155304",
"telephone_number": "251-769-9763"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6118 RIVERDALE AVE",
"city": "BRONX",
"state": "NY",
"postal_code": "104711009",
"telephone_number": "347-590-9915",
"fax_number": "212-202-6447"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "AUSTIN",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-02-24",
"last_updated": "2019-01-16",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist",
"state": "NY",
"license": "059713-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bronx, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.