Provider Demographics
NPI:1194170589
Name:WILLIAMS, ANDRE (DPT)
Entity type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 MADISON AVE RM 1026
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-7725
Mailing Address - Country:US
Mailing Address - Phone:212-682-7860
Mailing Address - Fax:
Practice Address - Street 1:295 MADISON AVE RM 1026
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-7725
Practice Address - Country:US
Practice Address - Phone:212-682-7860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43485225100000X
NY045014-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist