Healthcare Provider Details

I. General information

NPI: 1760105506
Provider Name (Legal Business Name): ANTHONY ANSELMO VILLANEUVA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date: 05/01/2023
Reactivation Date: 12/18/2025

III. Provider practice location address

5539 84TH ST.
ELMHURST NY
11373
US

IV. Provider business mailing address

5539 84TH ST.
ELMHURST NY
11373
US

V. Phone/Fax

Practice location:
  • Phone: 347-829-3890
  • Fax: 347-829-3888
Mailing address:
  • Phone: 347-829-3890
  • Fax: 347-829-3888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number048701-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: