Healthcare Provider Details

I. General information

NPI: 1861625907
Provider Name (Legal Business Name): TANISHIA WILLIAMS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2009
Last Update Date: 12/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3575 QUAKERBRIDGE RD
TRENTON NJ
08619-1271
US

IV. Provider business mailing address

3575 QUAKERBRIDGE RD
TRENTON NJ
08619-1271
US

V. Phone/Fax

Practice location:
  • Phone: 732-258-7065
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0008X
TaxonomyPediatric Neurodevelopmental Disabilities Physician
License Number25MA09380000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: