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General NPI Number Information
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NPI Number | 1164435624
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Entity Type | Individual
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Provider Name | LINDA VILLANUEVA M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/15/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 200 PARK AVE S
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City | NEW YORK
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State | NY
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Zip | 10003-1503
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Country | US
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Telephone | 212-780-4459
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Fax |
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Provider Business Mailing Address
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Address Line | 120 E 87TH ST APARTMENTP8B
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City | NEW YORK
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State | NY
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Zip | 10128-1116
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Country | US
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Telephone | 212-860-4554
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | NY 140305
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License Number State | NY
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