Provider Demographics
NPI:1699830380
Name:ELAINE WILLIAMS PAULINE MD
Entity Type:Organization
Organization Name:ELAINE WILLIAMS PAULINE MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAULINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-644-2495
Mailing Address - Street 1:325 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-3313
Mailing Address - Country:US
Mailing Address - Phone:718-644-2495
Mailing Address - Fax:
Practice Address - Street 1:325 E 7TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-3313
Practice Address - Country:US
Practice Address - Phone:718-644-2495
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005937174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02637603Medicaid
NY02637603Medicaid
NYU95464Medicare UPIN