Provider Demographics
NPI:1245579945
Name:VILLAMAR, MARILYN B (LAC, LMT)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:B
Last Name:VILLAMAR
Suffix:
Gender:F
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10005 92ND AVE
Mailing Address - Street 2:305
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-2909
Mailing Address - Country:US
Mailing Address - Phone:646-391-3041
Mailing Address - Fax:
Practice Address - Street 1:308 5TH AVE
Practice Address - Street 2:5TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3613
Practice Address - Country:US
Practice Address - Phone:646-391-3041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004917171100000X
NY024887-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist