MEDICARE: VINCENT L WILLIAMS LMT

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	174400000X	Specialist	020601	NY

General Provider Information

NPI Number	:	1386080711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINCENT L WILLIAMS LMT

Provider Business Mailing Address
First Line	:	343 ANGELO DR
Second Line	:
City	:	MONTGOMERY
State	:	NY
Zip	:	12549-1627
Country	:	US
Telephone Number	:	845-636-9635
Fax Number	:

Provider Business Practice Location Address
First Line	:	280 ROUTE 211 E
Second Line	:	STE 205
City	:	MIDDLETOWN
State	:	NY
Zip	:	10940-3109
Country	:	US
Telephone Number	:	845-775-3636
Fax Number	:	845-775-3635

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

Provider Enumeration Date	:	05/13/2013
Last Update Date	:	05/13/2013

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