Provider Demographics
NPI:1104631043
Name:WILLIAMS, JERMAUL
Entity type:Individual
Prefix:
First Name:JERMAUL
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 CLIFTON AVE APT D1413
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-1848
Mailing Address - Country:US
Mailing Address - Phone:908-357-4596
Mailing Address - Fax:908-357-4596
Practice Address - Street 1:25 CLIFTON AVE APT D1413
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-1848
Practice Address - Country:US
Practice Address - Phone:908-357-4596
Practice Address - Fax:908-357-4596
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker