1689760795 NPI number — DR. HUGO J VILLANUEVA MD

Table of content: DR. HUGO J VILLANUEVA MD (NPI 1689760795)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689760795 NPI number — DR. HUGO J VILLANUEVA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VILLANUEVA
Provider First Name:
HUGO
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689760795
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1239
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCARSDALE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10583-9239
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-636-8591
Provider Business Mailing Address Fax Number:
914-633-5084

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4141 CARPENTER AVE
Provider Second Line Business Practice Location Address:
RENAL UNIT
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10466-2600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-920-9041
Provider Business Practice Location Address Fax Number:
718-920-9043
Provider Enumeration Date:
10/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  211742 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7X3671 . This is a "BLUE CROSS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 211742 . This is a "HIP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01948145 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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