Provider Demographics
NPI:1548713142
Name:WILSON-EWING, TESSA (MD)
Entity type:Individual
Prefix:DR
First Name:TESSA
Middle Name:
Last Name:WILSON-EWING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:116 E 124TH ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-1933
Mailing Address - Country:US
Mailing Address - Phone:212-876-6083
Mailing Address - Fax:212-876-6092
Practice Address - Street 1:116 E 124TH ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-1933
Practice Address - Country:US
Practice Address - Phone:212-876-6083
Practice Address - Fax:212-876-6092
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-31
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY602858782084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry