Provider Demographics
NPI:1073161048
Name:VILLAMARIN, DORA
Entity Type:Individual
Prefix:
First Name:DORA
Middle Name:
Last Name:VILLAMARIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 E CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08312-1908
Mailing Address - Country:US
Mailing Address - Phone:631-782-8334
Mailing Address - Fax:
Practice Address - Street 1:26 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NJ
Practice Address - Zip Code:08312-1908
Practice Address - Country:US
Practice Address - Phone:631-782-8334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider