Individual
TERRY WILLIAMS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
104 BLOOMFIELD AVE, MONTCLAIR, NJ 07042-4723
(973) 783-6655
(973) 233-1396
Mailing address
309 E 22ND ST APT 7, PATERSON, NJ 07514-2247
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
POO559
NJ
175T00000X
Peer Specialist
—
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0580198
—
NJ
05
—
6385907
—
NJ
Enumeration date
04/21/2021
Last updated
06/08/2021
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