MEDICARE: MRS. TERESITA VILLAROSA NP

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
1	363LA2200X	Adult Health Nurse Practitioner	F301732	NY

Other Identifiers

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

General Provider Information

NPI Number	:	1457353880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TERESITA VILLAROSA NP

Provider Business Mailing Address
First Line	:	772 BROOK AVE
Second Line	:	APT B
City	:	BRONX
State	:	NY
Zip	:	10451-4677
Country	:	US
Telephone Number	:	212-523-4101
Fax Number	:	212-523-1077

Provider Business Practice Location Address
First Line	:	1111 AMSTERDAM AVE
Second Line	:	SLH- S&R 8TH FLOOR- EVALUATION UNIT
City	:	NEW YORK
State	:	NY
Zip	:	10025-1716
Country	:	US
Telephone Number	:	212-523-4101
Fax Number	:	212-523-1077

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	07/09/2007

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