=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275599961
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | OSBORNE D WILLIAMS MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/22/2006
-----------------------------------------------------
Last Update Date | 10/12/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1000 MONTAUK HIGHWAY GOOD SMARITAN HOSPITAL MEDICAL CENTER
-----------------------------------------------------
City | WEST ISLIP
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11795
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-376-4088
-----------------------------------------------------
Fax | 631-376-4539
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3 BOYLE RD
-----------------------------------------------------
City | SELDEN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11784-4000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-736-4064
-----------------------------------------------------
Fax | 631-736-1332
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | 194538
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------