MEDICARE: MRS. PAULETTE LELEITH WILLIAMS SPECIALIST

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		NY

General Provider Information

NPI Number	:	1720410301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PAULETTE LELEITH WILLIAMS SPECIALIST

Provider Business Mailing Address
First Line	:	11603 225TH ST
Second Line	:	CAMBRIA HEIGHTS
City	:	CAMBRIA HEIGHTS
State	:	NY
Zip	:	11411-1710
Country	:	US
Telephone Number	:	917-399-4054
Fax Number	:	718-528-1467

Provider Business Practice Location Address
First Line	:	11603 225TH ST
Second Line	:	CAMBRIA HEIGHTS
City	:	CAMBRIA HEIGHTS
State	:	NY
Zip	:	11411-1710
Country	:	US
Telephone Number	:	917-399-4054
Fax Number	:	718-528-1467

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

Provider Enumeration Date	:	08/06/2013
Last Update Date	:	08/06/2013

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