MEDICARE: MR. ANDREW D WILLIAMS RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	486152	NY

General Provider Information

NPI Number	:	1184854572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANDREW D WILLIAMS RN

Provider Business Mailing Address
First Line	:	855 SUMMIT AVE
Second Line	:
City	:	HACKENSACK
State	:	NJ
Zip	:	07601-1626
Country	:	US
Telephone Number	:	646-280-6356
Fax Number	:

Provider Business Practice Location Address
First Line	:	417 OCEAN AVE APT A6
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-1742
Country	:	US
Telephone Number	:	646-280-6356
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2009
Last Update Date	:	07/20/2009

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