Wilson Physical Medicine LLC

Primary specialty

Rehabilitation ChiropractorTaxonomy code 111NR0400X

License

38MC00385100 Issued in NJ

Legal business name

WILSON PHYSICAL MEDICINE LLC

Practice address

130 Maple Ave
Suite 7a
Red Bank, NJ 07701-1734

Phone

(732) 842-7004

NPI assigned

Jun 21, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Pamela Eileen Wilson, DCNPI 1033232830

Title

Owner

Phone

(732) 842-7004

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Pamela Eileen Wilson, D.C.

  • Rehabilitation Chiropractor
  • Red Bank, NJ
  • NPI 1033232830
  Medicare reassignment Authorized official
• Michele M Peters, MS, RDN

  • Registered Dietitian
  • Locust, NJ
  • NPI 1124469572
  NPD (past)
• Christine M Scarano Ward, PT, DPT

  • Physical Therapist
  • Red Bank, NJ
  • NPI 1447288857
  NPD (past)

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

{
    "created_epoch": "1308614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320796800000",
    "number": "1710273503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 MAPLE AVE",
            "address_2": "SUITE 7A",
            "city": "RED BANK",
            "state": "NJ",
            "postal_code": "077011734",
            "telephone_number": "732-842-7004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 MAPLE AVE",
            "address_2": "SUITE 7A",
            "city": "RED BANK",
            "state": "NJ",
            "postal_code": "077011734",
            "telephone_number": "732-842-7004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILSON PHYSICAL MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-21",
        "last_updated": "2011-11-09",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_middle_name": "EILEEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "732-842-7004",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111NR0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Rehabilitation",
            "state": "NJ",
            "license": "38MC00385100",
            "primary": true
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "NJ",
            "license": "40QA01025400",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI  ENTITY 1 INDIVIDUAL PROVIDER #",
            "identifier": "1033232830",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kathryn Wilkinson, PT, DPT
• Christina Madeline Williams, LPC
• Crystal Lee Williams, LAC
• Kiera J Williams, MSW, LSW
• Annette Lynne Wilmott, D.O.
• Kedaar Bernard Wilson
• Pamela Eileen Wilson, D.C.
• Wind of Change Mental Health Counseling LLC
• Robert E Wold, M.D.
• Brianna Wolff, DPT

• Rehabilitation Chiropractor in Red Bank, NJ
• Providers in Red Bank, NJ by specialty
• Rehabilitation Chiropractor in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.