Provider Demographics
NPI:1114723822
Name:WILLIAMS, JOHN EZRA
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:EZRA
Last Name:WILLIAMS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 NOBLEWOOD PL
Mailing Address - Street 2:
Mailing Address - City:WILLINGBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08046-1230
Mailing Address - Country:US
Mailing Address - Phone:856-952-2932
Mailing Address - Fax:
Practice Address - Street 1:201 MULLICA HILL RD
Practice Address - Street 2:
Practice Address - City:GLASSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08028-1702
Practice Address - Country:US
Practice Address - Phone:856-256-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-22
Last Update Date:2025-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program