Provider Demographics
NPI:1902091374
Name:JUSTIN WILLER MD,PC
Entity Type:Organization
Organization Name:JUSTIN WILLER MD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:WILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-887-1678
Mailing Address - Street 1:705 ARBUCKLE AVE
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-2703
Mailing Address - Country:US
Mailing Address - Phone:718-859-8920
Mailing Address - Fax:718-859-7438
Practice Address - Street 1:729 OCEAN PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-1113
Practice Address - Country:US
Practice Address - Phone:718-859-8920
Practice Address - Fax:718-859-7438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1748362084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01085625Medicaid
NYA61520Medicare UPIN
NY24E841Medicare PIN