Healthcare Provider Details

I. General information

NPI: 1376638247
Provider Name (Legal Business Name): OFELIA T. VILLAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 02/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 E TREMONT AVE
BRONX NY
10457-5304
US

IV. Provider business mailing address

9219 212TH ST
QUEENS VILLAGE NY
11428-1117
US

V. Phone/Fax

Practice location:
  • Phone: 718-518-3700
  • Fax: 718-294-6999
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number171408
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number171408
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: