Provider Demographics
NPI:1508836024
Name:WILLIAMS, MICHAELANGELO ARISTOTLE (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAELANGELO
Middle Name:ARISTOTLE
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:85 S HARRISON ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-1700
Mailing Address - Country:US
Mailing Address - Phone:973-395-9096
Mailing Address - Fax:973-395-9097
Practice Address - Street 1:85 S HARRISON ST
Practice Address - Street 2:SUITE 204
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-1700
Practice Address - Country:US
Practice Address - Phone:973-395-9096
Practice Address - Fax:973-395-9097
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD002309213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6884407Medicaid
NJWI804217Medicare ID - Type Unspecified
NJ6884407Medicaid