Basic Information
| Provider Information | |||||||||
| NPI: | 1043553738 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILKES | ||||||||
| FirstName: | KRISTEN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 280 MARIN BLVD | ||||||||
| Address2: | APT 14F | ||||||||
| City: | JERSEY CITY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3177537167 | ||||||||
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| Practice Location | |||||||||
| Address1: | 355 GRAND ST | ||||||||
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| City: | JERSEY CITY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 073024321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2019152000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2013 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 25MA10141400 | NJ | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.