Provider Demographics
NPI:1457419202
Name:AGPAOA, ULYSSES VILLEZA (MD)
Entity Type:Individual
Prefix:
First Name:ULYSSES
Middle Name:VILLEZA
Last Name:AGPAOA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-5120
Mailing Address - Country:US
Mailing Address - Phone:973-375-4634
Mailing Address - Fax:973-926-9164
Practice Address - Street 1:9 LINCOLN PARK
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-2301
Practice Address - Country:US
Practice Address - Phone:973-375-4634
Practice Address - Fax:973-926-9164
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA058809207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223698843OtherAETNA
NJ223698843OtherHORIZON
NJ60057421OtherHORIZON NJ HEALTH
NJ01000355301OtherUNITEDHEALTHCARE
NJ01000355302OtherUNITEDHEALTHCARE
NJ7472008Medicaid
NJ223698843OtherAETNA
NJ223698843OtherAETNA