MEDICARE: DR. REBA WILLIAMS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	184498	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053386003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REBA WILLIAMS MD

Provider Business Mailing Address
First Line	:	2301 5TH AVE
Second Line	:	STE 10II
City	:	NEW YORK
State	:	NY
Zip	:	10037-1638
Country	:	US
Telephone Number	:	212-283-4134
Fax Number	:	212-442-4003

Provider Business Practice Location Address
First Line	:	1476A E 48TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-3102
Country	:	US
Telephone Number	:	718-258-5602
Fax Number	:	718-258-5605

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	03/27/2015

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