Healthcare Provider Details

I. General information

NPI: 1659379865
Provider Name (Legal Business Name): GERARDO VILLARUZ ESTEVEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1931 OAK TREE RD SUITE 201
EDISON NJ
08820-2072
US

IV. Provider business mailing address

1931 OAK TREE RD SUITE 201
EDISON NJ
08820-2072
US

V. Phone/Fax

Practice location:
  • Phone: 732-452-0680
  • Fax: 732-452-9136
Mailing address:
  • Phone: 732-452-0680
  • Fax: 732-452-9136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA05968800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number25MA05968800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: