Healthcare Provider Details

I. General information

NPI: 1821534363
Provider Name (Legal Business Name): ALLAN VILLAPAZ RNFA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2017
Last Update Date: 01/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 EASTON AVE
NEW BRUNSWICK NJ
08901-1766
US

IV. Provider business mailing address

20 IVY ST
PISCATAWAY NJ
08854-4711
US

V. Phone/Fax

Practice location:
  • Phone: 732-745-8600
  • Fax: 732-745-1162
Mailing address:
  • Phone: 732-713-5571
  • Fax: 732-463-1109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number26NR05806400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: