MEDICARE: DR. WILBERT 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	207Q00000X	Family Medicine Physician	144240	NY

General Provider Information

NPI Number	:	1326114174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILBERT WILLIAMS MD

Provider Business Mailing Address
First Line	:	6 HEALTHY WAY
Second Line	:
City	:	ELLENVILLE
State	:	NY
Zip	:	12428-5612
Country	:	US
Telephone Number	:	845-647-4500
Fax Number	:	845-647-7632

Provider Business Practice Location Address
First Line	:	6 HEALTHY WAY
Second Line	:
City	:	ELLENVILLE
State	:	NY
Zip	:	12428-5612
Country	:	US
Telephone Number	:	845-647-4500
Fax Number	:	845-647-7632

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

Provider Enumeration Date	:	11/24/2006
Last Update Date	:	02/29/2012

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