1669497707 NPI number — MARIA C VILLAQUIRAN MD

Table of content: DR. MICHAEL JOSEPH SCOTTO DI CLEMENTE DPM (NPI 1902974819)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669497707 NPI number — MARIA C VILLAQUIRAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VILLAQUIRAN
Provider First Name:
MARIA
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1669497707
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
139 ROCK CREEK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLIFTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07014-2024
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-472-6677
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 LUDLOW ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07114-1108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-565-0355
Provider Business Practice Location Address Fax Number:
973-565-0461
Provider Enumeration Date:
07/12/2006

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: 208000000X , with the licence number:  MA08010600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0111325 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1740345693 . This is a "741 BROADWAY" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1972778413 . This is a "1150 SPRINGFIELD AVE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1932370483 . This is a "101 LUDLOW STREET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1235300799 . This is a "37 N DAY" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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