Provider Demographics
NPI:1841203411
Name:PACKARD, WILLIAM S (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:S
Last Name:PACKARD
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 1:887 OLD COUNTRY RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2115
Mailing Address - Country:US
Mailing Address - Phone:631-727-3596
Mailing Address - Fax:
Practice Address - Street 1:887 OLD COUNTRY RD
Practice Address - Street 2:SUITE D
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2115
Practice Address - Country:US
Practice Address - Phone:631-727-3596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1313862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB12148Medicare UPIN
NY28A691Medicare ID - Type Unspecified