1346393006 NPI number — FRED W WILLIAMS MD PC

Table of content: (NPI 1346393006)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346393006 NPI number — FRED W WILLIAMS MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRED W WILLIAMS MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1346393006
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5466
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRENTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08638-0466
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-406-1250
Provider Business Mailing Address Fax Number:
609-406-1249

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1450 PARKSIDE AV
Provider Second Line Business Practice Location Address:
SUITE 10
Provider Business Practice Location Address City Name:
TRENTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08638-2950
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-406-1250
Provider Business Practice Location Address Fax Number:
609-406-1249
Provider Enumeration Date:
01/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
FRED
Authorized Official Middle Name:
WAYNE
Authorized Official Title or Position:
CEO OWNER
Authorized Official Telephone Number:
609-406-1250

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  25MA04097100 , 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: 0085027000 . This is a "KEYSTONE HEALTH PLAN EAST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0468304 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2K5667 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0085027000 . This is a "AMERIHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0394723002 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 17988 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: MES055 . This is a "OXFORD HEALTH PLANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1034846 . This is a "HORIZON NJ HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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