Provider Demographics
NPI:1023049558
Name:VILLANOBOS, REY TANEO (MD)
Entity type:Individual
Prefix:DR
First Name:REY
Middle Name:TANEO
Last Name:VILLANOBOS
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:36 MUIRFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:MONROE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-5150
Mailing Address - Country:US
Mailing Address - Phone:732-656-9287
Mailing Address - Fax:
Practice Address - Street 1:9 CLYDE RD STE 102
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-5036
Practice Address - Country:US
Practice Address - Phone:732-828-2030
Practice Address - Fax:732-828-2043
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA06428100207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH23306Medicare UPIN