Provider Demographics
NPI:1205514031
Name:VILLALONA, MADELINE M
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:M
Last Name:VILLALONA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 FERDINAND PL
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-2509
Mailing Address - Country:US
Mailing Address - Phone:347-520-5866
Mailing Address - Fax:
Practice Address - Street 1:30 FERDINAND PL
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-2509
Practice Address - Country:US
Practice Address - Phone:347-520-5866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator