Provider Demographics
NPI:1023209863
Name:WILLIAMS, ANTON L (LPN)
Entity type:Individual
Prefix:
First Name:ANTON
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 BAYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MASTIC BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11951-5401
Mailing Address - Country:US
Mailing Address - Phone:631-314-2133
Mailing Address - Fax:
Practice Address - Street 1:152 BAYVIEW DR
Practice Address - Street 2:
Practice Address - City:MASTIC BEACH
Practice Address - State:NY
Practice Address - Zip Code:11951-5401
Practice Address - Country:US
Practice Address - Phone:631-314-2133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY265189-1164W00000X
NY94172301163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02206191Medicaid