Provider Demographics
NPI:1689842585
Name:DIODATO VILLAMENA MD
Entity Type:Organization
Organization Name:DIODATO VILLAMENA MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADELAIDE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:MAZZELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-779-9590
Mailing Address - Street 1:1 STONE PL STE 302
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-3427
Mailing Address - Country:US
Mailing Address - Phone:914-779-9590
Mailing Address - Fax:914-652-0052
Practice Address - Street 1:1 STONE PL STE 302
Practice Address - Street 2:
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-3427
Practice Address - Country:US
Practice Address - Phone:914-779-9590
Practice Address - Fax:914-652-0052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY114402174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY291971Medicare PIN