Provider Demographics
NPI:1699755520
Name:WILLIAMS, RICHARD ALEXANDER (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALEXANDER
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 1:964 AVENUE C
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002
Mailing Address - Country:US
Mailing Address - Phone:201-437-2772
Mailing Address - Fax:201-437-4372
Practice Address - Street 1:964 AVENUE C
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3023
Practice Address - Country:US
Practice Address - Phone:201-437-2772
Practice Address - Fax:201-437-4372
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA34873208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0879703Medicaid
NJ0879703Medicaid
NJ195428Medicare PIN