Provider Demographics
NPI:1114252715
Name:WILLIAMS, EDWARD A (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:A
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 MERMAID LN
Mailing Address - Street 2:UNIT 242
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-2499
Mailing Address - Country:US
Mailing Address - Phone:718-684-1832
Mailing Address - Fax:
Practice Address - Street 1:6110 QUEENS BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-5776
Practice Address - Country:US
Practice Address - Phone:718-397-2002
Practice Address - Fax:646-524-8323
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-15
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF-401226-1163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult