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NPI Code Detail

MEDICARE: JESSE S WILLIAMS MD

MEDICARE: JESSE S 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
1207R00000XInternal Medicine Physician102119NY
2208M00000XHospitalist Physician102119NY

General Provider Information

NPI Number : 1760485056
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSE S WILLIAMS MD
Provider Business Mailing Address
First Line : PO BOX 2004
Second Line :
City : EAST SYRACUSE
State : NY
Zip : 13057-4504
Country : US
Telephone Number : 315-362-5285
Fax Number : 315-445-2936
Provider Business Practice Location Address
First Line : 736 IRVING AVE
Second Line :
City : SYRACUSE
State : NY
Zip : 13210-1687
Country : US
Telephone Number : 315-470-8837
Fax Number : 315-470-2961
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2005
Last Update Date : 01/11/2010

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