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General NPI Number Information
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NPI Number | 1093234858
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Entity Type | Organization
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Legal Business Name | LIEZL VILLAVERDE, MD PC
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Dates
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Enumeration Date | 09/13/2017
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Last Update Date | 09/13/2017
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Provider Practice Location Address
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Address Line | 105 BYRNE AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10314
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Country | US
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Telephone | 718-698-7220
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Fax | 718-698-2004
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Provider Business Mailing Address
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Address Line | 105 BYRNE AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10314
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Country | US
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Telephone | 718-689-7220
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Fax | 718-698-2004
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. LIEZL VILLAVERDE
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Credential | MD
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Telephone | 718-698-7220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 210729
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License Number State | NY
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