Provider Demographics
NPI:1720062680
Name:WILLIAMS, ALLEN M (MD)
Entity type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:M
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 1:415 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2612
Mailing Address - Country:US
Mailing Address - Phone:631-521-7341
Mailing Address - Fax:631-521-7342
Practice Address - Street 1:415 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2612
Practice Address - Country:US
Practice Address - Phone:631-521-7341
Practice Address - Fax:631-521-7342
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223882207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02246091Medicaid
NY8K3381Medicare PIN
NYH55163Medicare UPIN