Provider Demographics
NPI:1023209863
Name:WILLIAMS, ANTON L (LPN)
Entity Type:Individual
Prefix:
First Name:ANTON
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 LEAF AVE
Mailing Address - Street 2:
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722-3936
Mailing Address - Country:US
Mailing Address - Phone:631-439-0576
Mailing Address - Fax:631-439-0576
Practice Address - Street 1:134 LEAF AVE
Practice Address - Street 2:
Practice Address - City:CENTRAL ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11722-3936
Practice Address - Country:US
Practice Address - Phone:631-439-0576
Practice Address - Fax:631-439-0576
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY265189-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02206191Medicaid