Provider Demographics
NPI:1538931134
Name:GENAO-ESTEVEZ, WILSON SAMUEL
Entity type:Individual
Prefix:MR
First Name:WILSON
Middle Name:SAMUEL
Last Name:GENAO-ESTEVEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:466 CORNELL PL
Mailing Address - Street 2:
Mailing Address - City:HILLSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07205-1747
Mailing Address - Country:US
Mailing Address - Phone:908-494-8886
Mailing Address - Fax:
Practice Address - Street 1:134 EVERGREEN PL STE 501-10
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-2011
Practice Address - Country:US
Practice Address - Phone:908-494-8886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-26
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle