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General NPI Number Information
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NPI Number | 1992644934
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Entity Type | Organization
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Legal Business Name | AW FAMILY HEALTH CLINIC LLC
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Dates
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Enumeration Date | 03/26/2026
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Last Update Date | 03/26/2026
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Provider Practice Location Address
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Address Line | 633 MAGNOLIA AVE
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City | LA PLACE
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State | LA
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Zip | 70068-3040
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Country | US
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Telephone | 718-362-1411
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Fax | 718-362-1651
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Provider Business Mailing Address
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Address Line | 612 CORPORATE WAY STE 2M
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City | VALLEY COTTAGE
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State | NY
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Zip | 10989-2027
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Country | US
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Telephone | 718-362-1411
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Fax | 718-362-1651
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Authorized Official
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Title or Position | NP/OWNER
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Name | TASHIBA WILLIAMS
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Credential |
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Telephone | 718-362-1411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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