Healthcare Provider Details

I. General information

NPI: 1396912887
Provider Name (Legal Business Name): INGRID WILLIAMS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

577 E. FORDHAM ROAD
BRONX NY
10458
US

IV. Provider business mailing address

577 E. FORDHAM ROAD
BRONX NY
10458
US

V. Phone/Fax

Practice location:
  • Phone: 347-590-0660
  • Fax: 347-590-0663
Mailing address:
  • Phone: 347-590-0660
  • Fax: 347-590-0663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number245654
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: