Healthcare Provider Details

I. General information

NPI: 1710959945
Provider Name (Legal Business Name): ELAINE R. WILLIAMS D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 03/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 GRAND CONCOURSE
BRONX NY
10451-3003
US

IV. Provider business mailing address

255 ALPINE RD
HENRYVILLE PA
18332-7103
US

V. Phone/Fax

Practice location:
  • Phone: 718-644-2495
  • Fax: 347-329-0688
Mailing address:
  • Phone: 718-644-2495
  • Fax: 347-329-0688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN005937
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: