Provider Demographics
NPI:1770632499
Name:VILLANOVA, LYNNEA (MD)
Entity Type:Individual
Prefix:DR
First Name:LYNNEA
Middle Name:
Last Name:VILLANOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:396 BROADWAY
Mailing Address - Street 2:SUITE 501
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-3500
Mailing Address - Country:US
Mailing Address - Phone:917-880-8518
Mailing Address - Fax:917-386-2586
Practice Address - Street 1:515 MADISON AVE
Practice Address - Street 2:SUITE 1720
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-5403
Practice Address - Country:US
Practice Address - Phone:212-758-3939
Practice Address - Fax:212-758-4244
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY203-848207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH36511Medicare UPIN