1932210804 NPI number — DR. ROBERT C WILLIAMS PHD

Table of content: DR. ROBERT C WILLIAMS PHD (NPI 1932210804)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932210804 NPI number — DR. ROBERT C WILLIAMS PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
ROBERT
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
M

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:
1932210804
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
726 COLUMBIA TPKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST GREENBUSH
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12061-2215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-479-4046
Provider Business Mailing Address Fax Number:
518-479-4090

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
726 COLUMBIA TPKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST GREENBUSH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12061-2215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-479-4046
Provider Business Practice Location Address Fax Number:
518-479-4090
Provider Enumeration Date:
08/31/2006

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: 103T00000X , with the licence number:  007679 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00926476 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 150129 . This is a "MHN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 41134 . This is a "MVP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 040426032141 . This is a "FIDELIS CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1036894 . This is a "METRACOMP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 132844 . This is a "VALUE OPTIONS; CDPHP; MHS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 61-73007 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6801263003 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7220089 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: PSY507679-4B . This is a "WORKERS COMP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000406637003 . This is a "BCBS; HEALTH INTEGRATED" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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