Provider Demographics
NPI:1740203355
Name:WILLIAMS, LYNNETTE P (MD)
Entity type:Individual
Prefix:DR
First Name:LYNNETTE
Middle Name:P
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 1:1783 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-4537
Mailing Address - Country:US
Mailing Address - Phone:212-348-6001
Mailing Address - Fax:
Practice Address - Street 1:22 E 130TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-3745
Practice Address - Country:US
Practice Address - Phone:901-270-6789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY185626207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02216517Medicaid
NY02216517Medicaid
NYE65859Medicare UPIN