Healthcare Provider Details

I. General information

NPI: 1750167185
Provider Name (Legal Business Name): GERALD WILLIAMS FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2023
Last Update Date: 09/01/2023
Certification Date: 09/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 E TREMONT AVE
BRONX NY
10460-2306
US

IV. Provider business mailing address

135 HIGH ST APT 1
YONKERS NY
10703-3353
US

V. Phone/Fax

Practice location:
  • Phone: 929-385-4299
  • Fax: 646-395-3823
Mailing address:
  • Phone: 646-337-3172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberF352717-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberF352717-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: