Provider Demographics
NPI:1376511535
Name:VILLAMENA, DIODATO JR (MD)
Entity Type:Individual
Prefix:
First Name:DIODATO
Middle Name:
Last Name:VILLAMENA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1 STONE PL
Mailing Address - Street 2:SUITE 302
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-3426
Mailing Address - Country:US
Mailing Address - Phone:914-779-9590
Mailing Address - Fax:914-652-0052
Practice Address - Street 1:1 STONE PL
Practice Address - Street 2:SUITE 302
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-3426
Practice Address - Country:US
Practice Address - Phone:914-779-9590
Practice Address - Fax:914-652-0052
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2010-01-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY114402207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00209421Medicaid
NY00209421Medicaid
C07922Medicare UPIN