Active NPI
Jeffrey Joseph Wilson, DDS
- Dentist
- Schenectady, NY
National Provider Identifier
1447425798
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 030221
- Practice address
- 1542 Union St
Schenectady, NY 12309 - Phone
- (518) 370-5234
- Fax
- (518) 372-4000
- NPI assigned
- Apr 28, 2008
- Sex
- Male
- Sole proprietor
- No
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 | 030221 | NY | Primary |
Addresses
Primary practice location
1542 Union St
Schenectady, NY 12309
Mailing address
1542 Union St
Schenectady, NY 12309
Phone (518) 370-5234
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00585460 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 030221 | NY | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1209340800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1209340800000",
"number": "1447425798",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1542 UNION ST",
"city": "SCHENECTADY",
"state": "NY",
"postal_code": "12309",
"telephone_number": "518-370-5234",
"fax_number": "518-372-4000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1542 UNION ST",
"city": "SCHENECTADY",
"state": "NY",
"postal_code": "12309",
"telephone_number": "518-370-5234",
"fax_number": "518-372-4000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "JEFFREY",
"middle_name": "JOSEPH",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-04-28",
"last_updated": "2008-04-28",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "030221",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00585460",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Schenectady, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.