Provider Demographics
NPI:1801865969
Name:WILLIAMS, CHRISTINE LUNDBERG (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:LUNDBERG
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 2ND STREET
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-7402
Mailing Address - Country:US
Mailing Address - Phone:914-582-6639
Mailing Address - Fax:914-723-3272
Practice Address - Street 1:300 2ND STREET
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-7402
Practice Address - Country:US
Practice Address - Phone:914-582-6639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY124863208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01023647Medicaid
NY01023647Medicaid