Provider Demographics
NPI:1114963428
Name:WILLIAMS, BRENT ALLAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:ALLAN
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:200 E 16TH ST
Mailing Address - Street 2:SUITE 12AB
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003
Mailing Address - Country:US
Mailing Address - Phone:646-638-4000
Mailing Address - Fax:646-638-1842
Practice Address - Street 1:314 W 14TH ST
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-5002
Practice Address - Country:US
Practice Address - Phone:646-638-4000
Practice Address - Fax:646-638-1842
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY213485207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00289194OtherRAILROAD MEDICARE
NY11229037OtherATLANTIS HEALTH PLAN
NY063AUOtherEMPIRE BCBS
NY2512046OtherGROUP HEALTH INSURANCE
NY2958686OtherAETNA HMO
NY2248366OtherFIRST HEALTH
NY2696461OtherOXFORD
NY3C5896OtherHEALTH NET
NY0186819-003OtherCIGNA
NY02310543Medicaid
NY611421582Other1199 NBF
NY7489419OtherAETNA PPO
NY611421582OtherMULTIPLAN
NY2244839OtherUNITED HEALTHCARE
NY247721AOtherMAGNACARE
NY11229037OtherATLANTIS HEALTH PLAN
NY611421582Other1199 NBF