Provider Demographics
NPI:1467608026
Name:DEBRA J WILLIAMS PODIATRIST PC
Entity Type:Organization
Organization Name:DEBRA J WILLIAMS PODIATRIST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST PC
Authorized Official - Prefix:MISS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:315-493-6949
Mailing Address - Street 1:720 STATE ST
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:NY
Mailing Address - Zip Code:13619-1404
Mailing Address - Country:US
Mailing Address - Phone:315-493-6949
Mailing Address - Fax:315-493-2445
Practice Address - Street 1:720 STATE ST
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:NY
Practice Address - Zip Code:13619-1404
Practice Address - Country:US
Practice Address - Phone:315-493-6949
Practice Address - Fax:315-493-2445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0044661261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1056500001Medicare NSC
NY51743BMedicare PIN