Provider Demographics
NPI:1144790189
Name:WILLIAMS HEALTH NP IN FAMILY HEALTH PLLC
Entity Type:Organization
Organization Name:WILLIAMS HEALTH NP IN FAMILY HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:718-496-7286
Mailing Address - Street 1:120 BENCHLEY PL APT 25H
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-3406
Mailing Address - Country:US
Mailing Address - Phone:718-496-7286
Mailing Address - Fax:718-671-8030
Practice Address - Street 1:316 E 149TH ST STE 8
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5602
Practice Address - Country:US
Practice Address - Phone:718-496-7286
Practice Address - Fax:718-671-8030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY025903020Medicaid