Healthcare Provider Details

I. General information

NPI: 1548271745
Provider Name (Legal Business Name): GERALD VILLANUEVA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 WATERSIDE PLZ APT 5E
NEW YORK NY
10010-2629
US

IV. Provider business mailing address

30 WATERSIDE PLZ APT 5E
NEW YORK NY
10010-2629
US

V. Phone/Fax

Practice location:
  • Phone: 212-448-0565
  • Fax:
Mailing address:
  • Phone: 212-448-0565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number191574
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: