=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982018081
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WILLIAM JAMES ASSOCIATES / BM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/17/2014
-----------------------------------------------------
Last Update Date | 06/17/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 225 PARK HILL AVE APT 1D
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10304-4765
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-494-2877
-----------------------------------------------------
Fax | 206-202-3912
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 225 PARK HILL AVE APT 1D
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10304-4765
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-561-2189
-----------------------------------------------------
Fax | 206-339-2565
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number | 206339
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------