Provider Demographics
NPI:1265794457
Name:VILMA JUNIO PHYSICIAN PLLC
Entity type:Organization
Organization Name:VILMA JUNIO PHYSICIAN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VILMA
Authorized Official - Middle Name:
Authorized Official - Last Name:JUNIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-342-4217
Mailing Address - Street 1:101 W UTICA ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-3165
Mailing Address - Country:US
Mailing Address - Phone:315-342-4217
Mailing Address - Fax:
Practice Address - Street 1:101 W UTICA ST
Practice Address - Street 2:SUITE B
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-3165
Practice Address - Country:US
Practice Address - Phone:315-342-4217
Practice Address - Fax:877-798-8125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-13
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY233306261QP2300X
NY525939261QP2300X
208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1124124334OtherNPI #
NY02605847Medicaid
1548417819OtherNPI #