Healthcare Provider Details

I. General information

NPI: 1922008887
Provider Name (Legal Business Name): DR. EDWIN WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 01/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1072 TROY SCHENECTADY RD
LATHAM NY
12110-1025
US

IV. Provider business mailing address

PO BOX 11716
ALBANY NY
12211-0716
US

V. Phone/Fax

Practice location:
  • Phone: 518-786-7000
  • Fax: 518-786-1160
Mailing address:
  • Phone: 518-786-7000
  • Fax: 518-786-1160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number174044
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number174044
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: