Provider Demographics
NPI:1669685616
Name:WILLIAMS, GWENDOLINE WARNER (LAC)
Entity Type:Individual
Prefix:MS
First Name:GWENDOLINE
Middle Name:WARNER
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1199 PARK AVE
Mailing Address - Street 2:APT 1J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1711
Mailing Address - Country:US
Mailing Address - Phone:917-566-5477
Mailing Address - Fax:
Practice Address - Street 1:1199 PARK AVENUE
Practice Address - Street 2:APT 1J
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1711
Practice Address - Country:US
Practice Address - Phone:917-566-5477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1752171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist