Provider Demographics
NPI:1659321982
Name:VILLELLA, JEANNINE A (DO)
Entity Type:Individual
Prefix:DR
First Name:JEANNINE
Middle Name:A
Last Name:VILLELLA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 MADISON AVE FL 12
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1009
Mailing Address - Country:US
Mailing Address - Phone:212-434-3770
Mailing Address - Fax:212-434-3775
Practice Address - Street 1:635 MADISON AVE FL 12
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1009
Practice Address - Country:US
Practice Address - Phone:212-434-3770
Practice Address - Fax:212-434-3775
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218520207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02175991Medicaid
NY02175991Medicaid
NY02175991Medicaid