Provider Demographics
NPI:1477707941
Name:TUMIKA WILLIAMS WILSON MD PC
Entity Type:Organization
Organization Name:TUMIKA WILLIAMS WILSON MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TUMIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:866-978-9963
Mailing Address - Street 1:58 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-2805
Mailing Address - Country:US
Mailing Address - Phone:866-978-9963
Mailing Address - Fax:866-978-9963
Practice Address - Street 1:221 W 138TH ST
Practice Address - Street 2:1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10030-2102
Practice Address - Country:US
Practice Address - Phone:866-978-9963
Practice Address - Fax:866-978-9963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY170317208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01140789Medicaid
NY1538228093OtherNPI