Provider Demographics
NPI:1013533835
Name:VILLANUEVA, EDGARDO JOSE TUAZON II (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:EDGARDO JOSE
Middle Name:TUAZON
Last Name:VILLANUEVA
Suffix:II
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 192ND ST APT 1500
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-3784
Mailing Address - Country:US
Mailing Address - Phone:917-498-7777
Mailing Address - Fax:
Practice Address - Street 1:6585 BROADWAY
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-2050
Practice Address - Country:US
Practice Address - Phone:718-549-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014572225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist