MEDICARE: JUSTIN WILLER MD,PC

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	2084N0400X	Neurology Physician	174836	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902091374
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUSTIN WILLER MD,PC

Provider Business Mailing Address
First Line	:	705 ARBUCKLE AVE
Second Line	:
City	:	WOODMERE
State	:	NY
Zip	:	11598-2703
Country	:	US
Telephone Number	:	718-859-8920
Fax Number	:	718-859-7438

Provider Business Practice Location Address
First Line	:	729 OCEAN PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-1113
Country	:	US
Telephone Number	:	718-859-8920
Fax Number	:	718-859-7438

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JUSTIN AARON WILLER
Credential	:	MD
Telephone Number	:	917-887-1678

Provider Enumeration Date	:	09/10/2007
Last Update Date	:	09/10/2007

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