Provider Demographics
NPI:1174836555
Name:VILLAMAR, EDWARD (CASAC)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:
Last Name:VILLAMAR
Suffix:
Gender:M
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2251 SEDGWICK AVE
Mailing Address - Street 2:4C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-5710
Mailing Address - Country:US
Mailing Address - Phone:646-488-5645
Mailing Address - Fax:
Practice Address - Street 1:804 E 138TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10454-1902
Practice Address - Country:US
Practice Address - Phone:718-665-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY17966282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital