Healthcare Provider Details

I. General information

NPI: 1043371966
Provider Name (Legal Business Name): JACQUELINE ANGELA WILLIAMS-PHILLIPS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACQUELINE ANGELA WILLIAMS MD

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 03/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ROBERT WOOD JOHNSON PL ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL - NEW BRUNSWICK
NEW BRUNSWICK NJ
08901-1928
US

IV. Provider business mailing address

1 ROBERT WOOD JOHNSON PL
NEW BRUNSWICK NJ
08901-1928
US

V. Phone/Fax

Practice location:
  • Phone: 732-235-7900
  • Fax:
Mailing address:
  • Phone: 732-235-7887
  • Fax: 732-235-6609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberMA60634
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: