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NPI Code Detail

MEDICARE: MR. EDGARDO JOSE TUAZON VILLANUEVA II OTR/L

MEDICARE: MR. EDGARDO JOSE TUAZON VILLANUEVA II OTR/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist014572NY

General Provider Information

NPI Number : 1013533835
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. EDGARDO JOSE TUAZON VILLANUEVA II OTR/L
Provider Business Mailing Address
First Line : 6700 192ND ST APT 1500
Second Line :
City : FRESH MEADOWS
State : NY
Zip : 11365-3784
Country : US
Telephone Number : 917-498-7777
Fax Number :
Provider Business Practice Location Address
First Line : 6585 BROADWAY
Second Line :
City : BRONX
State : NY
Zip : 10471-2050
Country : US
Telephone Number : 718-549-2200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2020
Last Update Date : 06/17/2020

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