Provider Demographics
NPI:1508885534
Name:VILLEGAS, ROBERT A (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:VILLEGAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 W PLEASANT AVE
Mailing Address - Street 2:SUITE334
Mailing Address - City:MAYWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07607-1335
Mailing Address - Country:US
Mailing Address - Phone:201-957-1090
Mailing Address - Fax:
Practice Address - Street 1:130 W PLEASANT AVE
Practice Address - Street 2:SUITE334
Practice Address - City:MAYWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07607-1335
Practice Address - Country:US
Practice Address - Phone:201-957-1090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME50505207L00000X
NJ25MA08090300207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL062262100Medicaid
NJ0135160Medicaid
FL062262100Medicaid
NJ0135160Medicaid
FL09872Medicare ID - Type Unspecified
NJ111020DBFMedicare PIN