Provider Demographics
NPI:1154431161
Name:WILLIAM K. POWER, MD, PA
Entity type:Organization
Organization Name:WILLIAM K. POWER, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:K
Authorized Official - Last Name:POWER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:609-693-9240
Mailing Address - Street 1:730 LACEY RD
Mailing Address - Street 2:SUITE G06
Mailing Address - City:FORKED RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08731-1300
Mailing Address - Country:US
Mailing Address - Phone:609-693-9240
Mailing Address - Fax:609-693-3616
Practice Address - Street 1:730 LACEY RD
Practice Address - Street 2:SUITE G06
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08731-1300
Practice Address - Country:US
Practice Address - Phone:609-693-9240
Practice Address - Fax:609-693-3616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04103700207RG0300X
NJNN96160363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0115048001OtherAMERIHEALTH
NJ4766105Medicaid
NJDE7355OtherRR MEDICARE
0115048001OtherAMERIHEALTH
NJDE7355OtherRR MEDICARE
NJ4766105Medicaid