Provider Demographics
NPI:1093027005
Name:VILLARD, JORGE (MD)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:VILLARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JORGE
Other - Middle Name:AUGUSTO
Other - Last Name:VILLAR CORTES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:353 E 83RD ST
Mailing Address - Street 2:APT. 10H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-4337
Mailing Address - Country:US
Mailing Address - Phone:212-734-6400
Mailing Address - Fax:
Practice Address - Street 1:353 E 83RD ST
Practice Address - Street 2:APT. 10H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-4337
Practice Address - Country:US
Practice Address - Phone:212-734-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-07
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1198212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB12899Medicare UPIN