Provider Demographics
NPI:1346686516
Name:REY T. VILLANOBOS MD, LLC
Entity Type:Organization
Organization Name:REY T. VILLANOBOS MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:REY
Authorized Official - Middle Name:TANEO
Authorized Official - Last Name:VILLANOBOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-828-2030
Mailing Address - Street 1:36 MUIRFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:MONROE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-5150
Mailing Address - Country:US
Mailing Address - Phone:732-828-2030
Mailing Address - Fax:732-828-2043
Practice Address - Street 1:9 CLYDE RD STE 102
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-5036
Practice Address - Country:US
Practice Address - Phone:732-828-2030
Practice Address - Fax:732-828-2043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-15
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H23306Medicare UPIN
041482Medicare PIN