Healthcare Provider Details

I. General information

NPI: 1215728274
Provider Name (Legal Business Name): CAROL ANN WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2025
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8825 163RD ST
JAMAICA NY
11432-4046
US

IV. Provider business mailing address

255 21ST ST
IRVINGTON NJ
07111-4425
US

V. Phone/Fax

Practice location:
  • Phone: 718-739-0045
  • Fax:
Mailing address:
  • Phone: 862-888-4369
  • Fax: 862-888-4369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number262347-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: