Provider Demographics
NPI:1699772624
Name:ANYAEGBUNAM, WILLIAM I (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:I
Last Name:ANYAEGBUNAM
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 1:2 EMMA LN
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-3763
Mailing Address - Country:US
Mailing Address - Phone:518-881-1888
Mailing Address - Fax:518-881-1893
Practice Address - Street 1:2 EMMA LN
Practice Address - Street 2:SUITE 202
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3763
Practice Address - Country:US
Practice Address - Phone:518-881-1888
Practice Address - Fax:518-881-1893
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205044207V00000X, 207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRB8763Medicare PIN