Provider Demographics
NPI:1922193721
Name:AMPARO, MARIA VILLANUEVA (PT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:VILLANUEVA
Last Name:AMPARO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 PALISADE AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-1101
Mailing Address - Country:US
Mailing Address - Phone:201-761-9490
Mailing Address - Fax:201-792-5343
Practice Address - Street 1:131 PALISADE AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-1101
Practice Address - Country:US
Practice Address - Phone:201-761-9490
Practice Address - Fax:201-792-5343
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA007998225100000X
NY018672225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ093307UG4Medicare ID - Type UnspecifiedRENDERING PHYSICIAN ID