Provider Demographics
NPI:1215329735
Name:WILKOS, ANGELA (PSYD)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:
Last Name:WILKOS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 COMMERCE DR STE 135
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-3614
Mailing Address - Country:US
Mailing Address - Phone:848-219-0136
Mailing Address - Fax:
Practice Address - Street 1:20 COMMERCE DR STE 135
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-3614
Practice Address - Country:US
Practice Address - Phone:848-219-0136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020529103T00000X, 103TC0700X
NJ35SI00571600103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04055029Medicaid
NYA400119684Medicare PIN