Active NPI
Dorian J. Wilson, M.D.
- Transplant Surgery Physician
- Newark, NJ
National Provider Identifier
1700811494
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Transplant Surgery Physician
- License
- 25MA04259200
- Practice address
- 30 Bergen St
Admc 12 1205
Newark, NJ 07107-3000 - Phone
- (973) 972-0037
- NPI assigned
- Jul 11, 2006
- 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 |
|---|---|---|---|---|
| Transplant Surgery Physician | 204F00000X | 25MA04259200 | NJ | Primary |
Addresses
Primary practice location
30 Bergen St
Admc 12 1205
Newark, NJ 07107-3000
Mailing address
30 Bergen St
Admc 12 1205
Newark, NJ 07107-3000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2008505 | Medicaid | NJ |
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25MA04259200 | NJ | MD | Transplant Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University Physician Associates of New Jersey Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Family Medicine Physician
- Newark, NJ
- NPI 1467462168
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152576000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1700811494",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30 BERGEN ST",
"address_2": "ADMC 12 1205",
"city": "NEWARK",
"state": "NJ",
"postal_code": "071073000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30 BERGEN ST",
"address_2": "ADMC 12 1205",
"city": "NEWARK",
"state": "NJ",
"postal_code": "071073000",
"telephone_number": "973-972-0037"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "DORIAN",
"middle_name": "J.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "204F00000X",
"taxonomy_group": "",
"desc": "Transplant Surgery",
"state": "NJ",
"license": "25MA04259200",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2008505",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Newark, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.