Provider Demographics
NPI:1881884229
Name:VILLAREAL, FREDERICK YABUT (NP)
Entity type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:YABUT
Last Name:VILLAREAL
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:DEREK
Other - Middle Name:
Other - Last Name:VILLAREAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:102 E ELIZABETH AVE APT 406
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-3168
Mailing Address - Country:US
Mailing Address - Phone:917-923-0536
Mailing Address - Fax:
Practice Address - Street 1:423 E 23RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-5011
Practice Address - Country:US
Practice Address - Phone:917-923-0536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY431496363LA2100X
NY22 580183163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care