Provider Demographics
NPI:1710310313
Name:BIZERRIL-WILLIAMS, JULIANA FONTENELE
Entity Type:Individual
Prefix:
First Name:JULIANA
Middle Name:FONTENELE
Last Name:BIZERRIL-WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JULIANA
Other - Middle Name:FONTENELE
Other - Last Name:BIZERRIL WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:200 WESTGATE CENTER BUSINESS DRIVE
Mailing Address - Street 2:SUITE 228
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524
Mailing Address - Country:US
Mailing Address - Phone:845-485-5000
Mailing Address - Fax:
Practice Address - Street 1:200 WESTGATE BUSINESS CENTER DRIVE
Practice Address - Street 2:SUITE 228
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524
Practice Address - Country:US
Practice Address - Phone:845-485-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016809-1363AM0700X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY016809-1OtherSTATE LICENSEE