Avril D Anthony-Wilson, M.D.
Individual provider Active NPI Family Medicine Physician · Hawthorne, NJ
NPI 1467517334 · NPPES record last updated Jun 11, 2014
Key facts
- NPI
- 1467517334
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 25MA07206200 (NJ)
- Practice address
- 1114 Goffle Rd
Hawthorne, NJ 07506-2014 - Phone
- (973) 423-1364
- Fax
- (973) 423-0980
- NPI assigned
- Dec 22, 2006
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25MA07206200 | NJ | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| TJH Medical Services, PC | Past | Accepting new patients | |
| TJH Medical Services, P.C. | Family Medicine | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 25MA07206200 | NJ | Yes |
Addresses
Primary practice location
1114 Goffle Rd
Hawthorne, NJ 07506-2014
Mailing address
1114 Goffle Rd
Hawthorne, NJ 07506-2014
Phone (973) 423-1364
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01920598 | Medicaid | NY |
Other providers in Hawthorne, NJ
- All Care Family Practice LLC
- Alliance Hand and Physical Therapy, P.C.
- Always There Inc
- Antonio Anamisis
- Anthony M Pallotta DDS PA
- Jennifer Lauren Apps
- Valentina Arias
- Aris RX Inc
- Lisa Ann Avent
- Axis Mundi Physical Therapy and Wellness P.C.
All providers in Hawthorne, NJ · Family Medicine Physician in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 11, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.