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NPI Code Detail

MEDICARE: BERNARDO R VILLAJUAN MD

MEDICARE: BERNARDO R VILLAJUAN MD
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
1207R00000XInternal Medicine Physician115492NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1033220397
Entity Type Code : Individual
Provider Name (Legal Business Name) : BERNARDO R VILLAJUAN MD
Provider Business Mailing Address
First Line : 9 CAREY RD
Second Line :
City : QUEENSBURY
State : NY
Zip : 12804-7880
Country : US
Telephone Number : 518-761-0300
Fax Number : 518-824-2388
Provider Business Practice Location Address
First Line : 319 BROADWAY
Second Line :
City : FORT EDWARD
State : NY
Zip : 12828-1221
Country : US
Telephone Number : 518-761-0300
Fax Number : 518-480-0119
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2006
Last Update Date : 01/31/2017

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Directions to “ BERNARDO R VILLAJUAN MD” Practice Location

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