Provider Demographics
NPI:1386080711
Name:WILLIAMS, VINCENT L (LMT)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 ANGELO DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:NY
Mailing Address - Zip Code:12549-1627
Mailing Address - Country:US
Mailing Address - Phone:845-636-9635
Mailing Address - Fax:
Practice Address - Street 1:280 ROUTE 211 E
Practice Address - Street 2:STE 205
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-3109
Practice Address - Country:US
Practice Address - Phone:845-775-3636
Practice Address - Fax:845-775-3635
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-13
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020601174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist