1225114531 NPI number — DR. JOSE LICUANAN VILLALUZ M.D.

Table of content: DR. JOSE LICUANAN VILLALUZ M.D. (NPI 1225114531)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225114531 NPI number — DR. JOSE LICUANAN VILLALUZ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VILLALUZ
Provider First Name:
JOSE
Provider Middle Name:
LICUANAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1225114531
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 EAST 42ND STREET
Provider Second Line Business Mailing Address:
APT. # 1505
Provider Business Mailing Address City Name:
NEW
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-873-0585
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 W 86TH ST
Provider Second Line Business Practice Location Address:
SUITE # 507
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10024-3666
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-873-0585
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/29/2006

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: 2084P0800X , with the licence number:  232191 , 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)





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