MEDICARE: DR. EMILIO B VILLEGAS 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
1	208000000X	Pediatrics Physician	178777	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	:	1629048434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EMILIO B VILLEGAS MD

Provider Business Mailing Address
First Line	:	9320 ROOSEVELT AVE
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-7911
Country	:	US
Telephone Number	:	718-404-9086
Fax Number	:	877-634-1286

Provider Business Practice Location Address
First Line	:	9320A ROOSEVELT AVE
Second Line	:	SUITE 2A
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-7944
Country	:	US
Telephone Number	:	718-404-9086
Fax Number	:	877-634-1286

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

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	12/11/2012

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