Healthcare Provider Details

I. General information

NPI: 1104453810
Provider Name (Legal Business Name): JOHN VILLEGAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 VAN WYCK EXPY
RICHMOND HILL NY
11418-2897
US

IV. Provider business mailing address

8900 VAN WYCK EXPY
RICHMOND HILL NY
11418-2897
US

V. Phone/Fax

Practice location:
  • Phone: 718-206-7957
  • Fax:
Mailing address:
  • Phone: 718-206-7957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number334720
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number64393
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number334720
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: