Provider Demographics
NPI:1295165777
Name:WILLIAM, PUSHPAM MARY (NP)
Entity type:Individual
Prefix:MRS
First Name:PUSHPAM
Middle Name:MARY
Last Name:WILLIAM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 DELMONICO AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-3410
Mailing Address - Country:US
Mailing Address - Phone:973-704-5202
Mailing Address - Fax:
Practice Address - Street 1:719 ROUTE 22 W
Practice Address - Street 2:
Practice Address - City:NORTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-4924
Practice Address - Country:US
Practice Address - Phone:908-561-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00324000363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics