Provider Demographics
NPI:1063416501
Name:DAVIS, WILLIAM L JR (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:L
Last Name:DAVIS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:507 AIRPORT EXECUTIVE PARK
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-5238
Mailing Address - Country:US
Mailing Address - Phone:845-262-5313
Mailing Address - Fax:845-262-5330
Practice Address - Street 1:327 ROUTE 59
Practice Address - Street 2:
Practice Address - City:AIRMONT
Practice Address - State:NY
Practice Address - Zip Code:10952
Practice Address - Country:US
Practice Address - Phone:845-356-2900
Practice Address - Fax:845-356-7797
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213531207XX0005X
NJ25MA07797000207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY361012OtherMVP (MONROE)
NY5956750OtherAETNA PPO
NY01948512Medicaid
NY2695H1OtherEMPIRE BCBS (STONY POINT)
NY2695H3OtherEMPIRE BCBS (AIRMONT)
NY5902684OtherGHI PPO
NY132721370OtherTAX ID#
NY0D1365OtherHEALTHNET
NY200037035OtherRAILROAD MEDICARE
NY2695H2OtherEMPIRE BCBS (MONROE)
NY2176547OtherAETNA HMO
NY361012OtherMVP (AIRMONT/STONY POINT)
NYP1310314OtherOXFORD
G93564Medicare UPIN
NY84G6013491Medicare PIN
NJ095286UN2Medicare PIN