1720316565 NPI number — STACY WILLIAMS MSW

Table of content: STACY WILLIAMS MSW (NPI 1720316565)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720316565 NPI number — STACY WILLIAMS MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
STACY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720316565
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/27/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1220
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PERTH AMBOY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08862-1220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-376-9333
Provider Business Mailing Address Fax Number:
732-324-5765

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
741 BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07104-4309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-675-1900
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/04/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  44SC04604600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 222747589 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".