Provider Demographics
NPI:1902482599
Name:WILLIAMS, REGINA ASKIA (NURSE PRACTITIONER(F)
Entity type:Individual
Prefix:MS
First Name:REGINA
Middle Name:ASKIA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER(F
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 ENGLE STREET
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2446
Mailing Address - Country:US
Mailing Address - Phone:347-416-2405
Mailing Address - Fax:
Practice Address - Street 1:185 ENGLE STREET
Practice Address - Street 2:SUITE 2B
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2446
Practice Address - Country:US
Practice Address - Phone:201-541-4052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15003000363LF0000X
NYF342981363LF0000X
NJ26NR15003000363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0982318Medicaid