Individual provider Active NPI

Edwin Williams

  • Otolaryngology Physician
  • Latham, NY
National Provider Identifier
1922008887
Registry record updated Jan 7, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
174044 Issued in NY
Practice address
1072 Troy Schenectady Rd
Latham, NY 12110-1025
Phone
(518) 786-7000
Fax
(518) 786-1160
NPI assigned
Jul 21, 2005
Last updated
Jan 7, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 174044 NY Primary
Plastic and Reconstructive Surgery Physician 2086S0122X 174044 NY

Addresses

Primary practice location

1072 Troy Schenectady Rd
Latham, NY 12110-1025

Mailing address

PO Box 11716
Albany, NY 12211-0716
Phone (518) 786-7000

Other identifiers 1

IdentifierTypeStateIssuer
01343851MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, VI2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20090824000486 NY Practitioner - OtolaryngologyPractitioner - Plastic and Reconstructive Surgery 3971417767 Reassigns benefits to 1 organization
I20151228001360 VI Practitioner - Plastic and Reconstructive Surgery 3971417767 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
174044NYMDPlastic and Reconstructive Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
New England Laser and Cosmetic Surgery Center LLC CurrentSince Nov 15, 2003 Accepting new patients
Edwin F Williams III MD Facial Plastic Surgery, PLLC Otolaryngology CurrentSince Apr 1, 1997 Accepting new patients
Comprehensive Orthopedics LLC CurrentSince Dec 1, 2015 Accepting new patients
New England Laser and Cosmetic Surgry Center LLC Current Accepting new patients
Eye Clinic,LLC PastSince Aug 1, 2004 Accepting new patients
Albany Medical College Otolaryngology Past Accepting new patients

Locations

1072 Troy Schenectady Rd
Latham, NY 12110
Phone (518) 283-2402

9151 Estate Thomas
Ste 206
St Thomas, VI 00802

Organizations & group practices 6

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

NPI Registry JSON

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

{
    "created_epoch": "1121904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1389052800000",
    "number": "1922008887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11716",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122110716",
            "telephone_number": "518-786-7000",
            "fax_number": "518-786-1160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1072 TROY SCHENECTADY RD",
            "city": "LATHAM",
            "state": "NY",
            "postal_code": "121101025",
            "telephone_number": "518-786-7000",
            "fax_number": "518-786-1160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "EDWIN",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-21",
        "last_updated": "2014-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "NY",
            "license": "174044",
            "primary": true
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "NY",
            "license": "174044",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01343851",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Latham, NY

Sources for this page

Verify at the official NPI Registry.