Provider Demographics
NPI:1578790440
Name:VILLAFANA, JUAN HILARIO (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:HILARIO
Last Name:VILLAFANA
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 1:3716 108TH ST
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-2025
Mailing Address - Country:US
Mailing Address - Phone:718-651-4000
Mailing Address - Fax:718-424-7776
Practice Address - Street 1:3716 108TH ST
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-2025
Practice Address - Country:US
Practice Address - Phone:718-651-4000
Practice Address - Fax:718-424-7776
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT047774208000000X
NY251095208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics