Provider Demographics
NPI:1003457086
Name:NITURAL, BRYAN JOEL VILLANUEVA (DPT)
Entity Type:Individual
Prefix:MR
First Name:BRYAN JOEL
Middle Name:VILLANUEVA
Last Name:NITURAL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3975 56TH ST APT 1J
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-8904
Mailing Address - Country:US
Mailing Address - Phone:929-245-6596
Mailing Address - Fax:347-332-1651
Practice Address - Street 1:820 2ND AVE RM 6A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-4530
Practice Address - Country:US
Practice Address - Phone:929-245-6596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038911208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation