Provider Demographics
NPI:1508838434
Name:VILLANUEVA, RONALD B (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:B
Last Name:VILLANUEVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1255 ROUTE 70 STE 20N
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-6192
Mailing Address - Country:US
Mailing Address - Phone:732-908-2200
Mailing Address - Fax:732-908-8111
Practice Address - Street 1:1255 ROUTE 70 STE 20N
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-6192
Practice Address - Country:US
Practice Address - Phone:732-908-2200
Practice Address - Fax:732-908-8111
Is Sole Proprietor?:No
Enumeration Date:2006-02-04
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07714100207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH30592Medicare UPIN