Provider Demographics
NPI:1366489650
Name:VILLARIN, JOSE M (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:M
Last Name:VILLARIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4250 BROADWAY RM 1C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-3768
Mailing Address - Country:US
Mailing Address - Phone:212-740-3900
Mailing Address - Fax:212-740-8232
Practice Address - Street 1:4250 BROADWAY RM 1C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-3768
Practice Address - Country:US
Practice Address - Phone:212-740-3900
Practice Address - Fax:212-740-8232
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2015-01-15
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Provider Licenses
StateLicense IDTaxonomies
NY163346-1208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00931833Medicaid
NYA64275Medicare UPIN