Provider Demographics
NPI:1689725160
Name:TUCKER, WILLIAM MORRIS (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MORRIS
Last Name:TUCKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 COLUMBUS AVE APT 24A
Mailing Address - Street 2:APT. 24-A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-5971
Mailing Address - Country:US
Mailing Address - Phone:212-579-2520
Mailing Address - Fax:
Practice Address - Street 1:150 COLUMBUS AVE APT 24A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-5971
Practice Address - Country:US
Practice Address - Phone:212-579-2520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106428-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
C12473Medicare UPIN
957351Medicare ID - Type Unspecified