Provider Demographics
NPI:1285947853
Name:WILLIAMS, SINCERE A
Entity type:Individual
Prefix:
First Name:SINCERE
Middle Name:A
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1535 UNIVERSITY BLVD
Mailing Address - Street 2:SUITE 13C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-7511
Mailing Address - Country:US
Mailing Address - Phone:347-615-0147
Mailing Address - Fax:
Practice Address - Street 1:1535 UNIVERSITY BLVD
Practice Address - Street 2:SUITE 13C
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-7511
Practice Address - Country:US
Practice Address - Phone:347-615-0147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-23
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLW4527817632222172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver