=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023412525
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CERLAR MEDICINE, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/14/2014
-----------------------------------------------------
Last Update Date | 10/14/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 365 NY 304 SUITE 204
-----------------------------------------------------
City | BARDONIA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10954
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-533-0270
-----------------------------------------------------
Fax | 845-623-3714
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 RELLA BLVD
-----------------------------------------------------
City | MONTEBELLO
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10901-4241
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-533-0270
-----------------------------------------------------
Fax | 845-623-3714
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. RYNA VILLAR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 845-533-0270
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 228195
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------