Provider Demographics
NPI:1588774657
Name:WILLIAMS, BERESTRAND W (MD)
Entity type:Individual
Prefix:
First Name:BERESTRAND
Middle Name:W
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 BERGENLINE AVENUE
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093
Mailing Address - Country:US
Mailing Address - Phone:201-758-9100
Mailing Address - Fax:201-758-9511
Practice Address - Street 1:6701 BERGENLINE AVENUE
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093
Practice Address - Country:US
Practice Address - Phone:201-758-9100
Practice Address - Fax:201-758-9511
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07331200207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ572921Medicare ID - Type Unspecified
F38176Medicare UPIN