Provider Demographics
NPI:1437162831
Name:WILLIAMS, DANIEL EDWIN (PHD, ABPP)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:EDWIN
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PHD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 CENTRAL AVE STE 615
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-3319
Mailing Address - Country:US
Mailing Address - Phone:973-675-9200
Mailing Address - Fax:973-678-8432
Practice Address - Street 1:185 CENTRAL AVE STE 615
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-3319
Practice Address - Country:US
Practice Address - Phone:973-675-9200
Practice Address - Fax:973-678-8432
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ897174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0492400Medicaid
NJ091511Medicare ID - Type UnspecifiedMEDICARE NUMBER