Provider Demographics
NPI:1215151428
Name:WILLIAMS, DAISY (PT)
Entity type:Individual
Prefix:MRS
First Name:DAISY
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 121
Mailing Address - Street 2:
Mailing Address - City:SOUND BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11789-0121
Mailing Address - Country:US
Mailing Address - Phone:516-659-5435
Mailing Address - Fax:
Practice Address - Street 1:3 TECHNOLOGY DR STE 400
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-4078
Practice Address - Country:US
Practice Address - Phone:631-751-8000
Practice Address - Fax:631-751-8030
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016188-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist