Provider Demographics
NPI:1609350719
Name:WILLIAMS, TODD STEPHEN (MEDICAL DEVICE SUPP)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:STEPHEN
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MEDICAL DEVICE SUPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 732
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-0732
Mailing Address - Country:US
Mailing Address - Phone:516-729-2601
Mailing Address - Fax:
Practice Address - Street 1:166 HERRICKS RD
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-2206
Practice Address - Country:US
Practice Address - Phone:516-729-2601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-24
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies