Individual provider Active NPI

Jacqueline Angela Williams-Phillips, MD

  • Pediatric Critical Care Medicine Physician
  • New Brunswick, NJ
National Provider Identifier
1043371966
Registry record updated Mar 13, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Critical Care Medicine PhysicianTaxonomy code 2080P0203X
License
MA60634 Issued in NJ
Practice address
1 Robert Wood Johnson PL
Robert Wood Johnson University Hospital - New Brunswick
New Brunswick, NJ 08901-1928
Phone
(732) 235-7900
NPI assigned
Dec 13, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Critical Care Medicine Physician 2080P0203X MA60634 NJ Primary

Addresses

Primary practice location

1 Robert Wood Johnson PL
Robert Wood Johnson University Hospital - New Brunswick
New Brunswick, NJ 08901-1928

Mailing address

1 Robert Wood Johnson PL
New Brunswick, NJ 08901-1928
Phone (732) 235-7887

Other identifiers 1

IdentifierTypeStateIssuer
6222307MedicaidNJ

Other names 1

  • Jacqueline Angela Williams Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100215000738 NJ Practitioner - Pediatric Medicine 0749324705 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MA60634NJMDPediatric Critical Care Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Rutgers Health-RWJ Pediatric Critical Care CurrentSince Jul 30, 1994 Accepting new patients
Rutgers Health-RWJ Pediatric Critical Care CurrentSince Jul 30, 1994 Accepting new patients

Locations

1 Rwj Pl
New Brunswick, NJ 08901
Phone (732) 235-7887

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1394668800000",
    "number": "1043371966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 ROBERT WOOD JOHNSON PL",
            "city": "NEW BRUNSWICK",
            "state": "NJ",
            "postal_code": "089011928",
            "telephone_number": "732-235-7887",
            "fax_number": "732-235-6609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 ROBERT WOOD JOHNSON PL",
            "address_2": "ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL - NEW BRUNSWICK",
            "city": "NEW BRUNSWICK",
            "state": "NJ",
            "postal_code": "089011928",
            "telephone_number": "732-235-7900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS-PHILLIPS",
        "first_name": "JACQUELINE",
        "middle_name": "ANGELA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-13",
        "last_updated": "2014-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "NJ",
            "license": "MA60634",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6222307",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "WILLIAMS",
            "middle_name": "ANGELA",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in New Brunswick, NJ

Sources for this page

Verify at the official NPI Registry.