Provider Demographics
NPI:1053386003
Name:WILLIAMS, REBA (MD)
Entity type:Individual
Prefix:DR
First Name:REBA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 5TH AVE
Mailing Address - Street 2:STE 10II
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037-1638
Mailing Address - Country:US
Mailing Address - Phone:212-283-4134
Mailing Address - Fax:212-442-4003
Practice Address - Street 1:1476A E 48TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-3102
Practice Address - Country:US
Practice Address - Phone:718-258-5602
Practice Address - Fax:718-258-5605
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY184498207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01897263Medicaid
NY01897263Medicaid