Healthcare Provider Details

I. General information

NPI: 1003311127
Provider Name (Legal Business Name): MICHAEL ANTHONY WILLIAMS-HEALY APN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 POLIFLY RD
HACKENSACK NJ
07601-1758
US

IV. Provider business mailing address

3 UNIVERSITY PLZ STE 205
HACKENSACK NJ
07601-6208
US

V. Phone/Fax

Practice location:
  • Phone: 201-343-6360
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00810700
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: