MEDICARE: AUREVIA MEDICAL LLC

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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1568338663
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUREVIA MEDICAL LLC

Provider Business Mailing Address
First Line	:	140 BERKELEY PL APT 1
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11217-3968
Country	:	US
Telephone Number	:	917-756-2312
Fax Number	:	919-443-1034

Provider Business Practice Location Address
First Line	:	640 PARK AVE
Second Line	:
City	:	HOBOKEN
State	:	NJ
Zip	:	07030-4176
Country	:	US
Telephone Number	:	201-275-3698
Fax Number	:	919-443-1034

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	DR. LYNNEA VILLANOVA
Credential	:	MD
Telephone Number	:	917-756-2312

Provider Enumeration Date	:	10/15/2025
Last Update Date	:	10/15/2025

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