1265609168 NPI number — MR. VIRGILIO VILLANUEVA ASUELO JR. PHYSICAL THERAPIST

Table of content: MR. VIRGILIO VILLANUEVA ASUELO JR. PHYSICAL THERAPIST (NPI 1265609168)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265609168 NPI number — MR. VIRGILIO VILLANUEVA ASUELO JR. PHYSICAL THERAPIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ASUELO
Provider First Name:
VIRGILIO
Provider Middle Name:
VILLANUEVA
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
PHYSICAL THERAPIST
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:
1265609168
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9019 210TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
QUEENS VILLAGE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11428-1018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-740-5432
Provider Business Mailing Address Fax Number:
718-740-5432

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6135 WOODHAVEN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REGO PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11374-2739
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-429-6630
Provider Business Practice Location Address Fax Number:
718-429-6584
Provider Enumeration Date:
05/11/2008

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: 225100000X , with the licence number:  025361 , 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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